Active Inflammatory Changes Research Articles

The ATTRACT study: screening for the early identification of axial psoriatic arthritis in a cohort of Italian psoriatic patients.

There is growing interest in the early identification of patients with axial PsA (axPsA). We aimed to evaluate whether a dermatology-based screening strategy could help to identify axPsA patients. The dermatologist-centred screening (DCS) questionnaire was administrated by dermatologists to consecutive patients fulfilling the inclusion criteria [(i) age ≥18 years and (ii) clinical diagnosis of psoriasis made by a dermatologist] to identify patients eligible (affirmative answers 1-3c of the DCS) for rheumatological evaluation. Clinical, laboratory, genetic and imaging data were collected from all referred patients. Among the 365 patients screened, 265 fulfilled the inclusion criteria and 124/265 (46.8%) were eligible for rheumatological referral. Diagnosis of axPsA, with or without peripheral PsA (pPsA), was made in 36/124 (29.0%) patients; pPsA without axial involvement was found in 21/124 (16.9%) patients. Back pain at screening was recorded in 174 (66%) patients, with 158 (60%) reporting a back pain duration longer than 3 months and 140 (53%) reporting back pain onset before the age of 45 years. Active inflammatory and/or structural post-inflammatory changes in the sacroiliac joints and/or spine were observed in all axPsA patients. Patients with PsA showed a numerically longer duration of back pain and higher CRP levels in comparison with patients with psoriasis without PsA. The DCS tool proved to be a valuable screening strategy for detecting and characterizing patients with axPsA in a real-life cohort of psoriasis patients in a dermatological setting and helped to identify a substantial number of patients affected by undiagnosed pPsA.

Early identification of axial psoriatic arthritis among patients with psoriasis: a prospective multicentre study

ObjectivesTo evaluate a dermatologist-centred screening tool followed by a structured rheumatological examination including MRI of sacroiliac joints and spine for the recognition of psoriatic arthritis with axial involvement (axPsA).MethodsThis was...

Skin care of atopic dermatitis in a beauty salon

Due to the over-reactivity to all stimuli, the skin of people suffering from atopic dermatitis (AD) is a challenge for a cosmetologist. The article reviews professional methods of skin care for people with AD. In addition, it also presents the main ingredients in the preparations recommended for this kind of skin. Properly selected and carried out procedures significantly improve the skin condition, and thus develop both the physical and emotional comfort of the patient’s life. Any activities related to the professional care of this type of skin should only be carried out during the remission of any active inflammatory changes in the skin.

A Narrative Review of the Design of Ultrasound Indices for Detecting Enthesitis.

With the increased utilization of musculoskeletal ultrasound in clinical practice, there has been rapid proliferation of publications on sonographic evaluation of enthesitis. This has led to the development of multiple new approaches to scoring sonographic findings in the detection of enthesitis, with variations including entheseal sites and sonographic features that limit cross-study comparisons. Furthermore, despite efforts to standardize the definition of enthesitis, there is still heterogeneity in the sonographic features included in existing ultrasound scores, and additional adjustments are required to distinguish active inflammatory changes from non-inflammatory conditions and to adjust for demographic features associated with increased prevalence of abnormal sonographic findings. This review provides an update on the current landscape of ultrasound scoring systems for enthesitis and emphasizes the importance of future data-based ultrasound scoring systems to improve the distinction between inflammatory and non-inflammatory or degenerative changes of the enthesis.

Influence of Blastocystis hominis on the small intestine and lactase enzyme activity.

Blastocystis hominis is a cosmopolitan protozoan that has been associated with several gastrointestinal disturbances involving lactose intolerance. However, the underlying pathogenic factors remain indistinct. 20 Swiss albino mice were utilized and assembled into four groups, each of five mice: group-I: received neither infection nor lactose (healthy control), group-II: received a single dose of 10,000 cysts of Blastocystis and lactose diets in a dose of 12.5g/day/mouse for 7 consecutive days starting from day 14 p.i., group-III: non-infected mice with oral doses of lactose (12.5g/day/mouse) for 7 consecutive days (positive control), group-IV: infected mice on lactose free diet (negative control). We investigated the histopathological changes using H&E stain.s Also, lactase enzyme activity was measured using spectrophotometry and the production of TNF-α and apoptotic events were explored via immunohistochemistry and compared in the small intestine of all groups. The active inflammatory changes in the infected animals were moderate in the form of loss of villous architecture, increased ILC (P-value > 0.001) besides scattered forms of the parasite as compared to non-infected mice. There was a reduction in lactase enzyme activity p.i. The TNF-α levels were induced p.i. as compared to non-infected mice (P-value > 0.001). The expression of Bax protein was upgraded, while Bcl-2 expression decreased significantly with a reverse in Bax/Bcl2 ratio in infected animals. Blastocystis infection appears to humble lactase enzyme activity via the induction of apoptosis in the epithelial cells of the small intestinal brush border in a TNF-α associative pathway.

MRI Changes of the Symphysis Pubis in Patients With Axial Spondyloarthritis and Association With Clinical Factors.

This study aimed to evaluate the magnetic resonance imaging (MRI) changes of the symphysis pubis in patients with axial spondyloarthritis (ax-SpA) and to assess its association with clinical factors. A retrospective analysis of 172 patients with ax-SpA was performed to assess the presence of active inflammatory and structural changes of the symphysis pubis on MRI scans, and their association with clinical factors and the SPARCC (Spondyloarthritis Research Consortium of Canada) scoring of the sacroiliac joint were evaluated. The proportions of active inflammation and structural changes of the symphysis pubis were 69/172 (40.1%) and 54/172 (31.4%), respectively. When comparing the active inflammation and no-active inflammation symphysis pubis groups, the former had higher level C-reactive protein, higher erythrocyte sedimentation rate, and younger median age of patients. Moreover, no significant correlation was noted between the active inflammation of the symphysis pubis and SPARCC score of the sacroiliac joint. When comparing the normal and abnormal symphysis pubis groups, the latter had longer symptom duration. The MRI changes of the symphysis pubis were seen in 55.2% of the patients with ax-SpA and were associated with C-reactive protein, erythrocyte sedimentation rate, and symptom duration.

Drug-induced uveitis

In recent years, an increasing amount of attention has been paid to medicinal products as possible risk factors in the development of eye diseases. The frequency of diagnosed drug-induced uveitis is growing yearly, which can be attributed to the appearance of new drugs - biological agents (immune checkpoint inhibitors, BRAF and MEK inhibitors, vascular endothelial growth factor inhibitors, tumor necrosis factor-α inhibitors), as well as systemic bisphosphonates and some antiviral drugs. The time interval between the beginning of the drug use and the appearance of uveitis symptoms varies from several days to months. Common symptoms include eye pain, photophobia, the appearance of floating opacities, and reduced vision associated with active inflammatory changes in the retina and optic nerve and outcomes of those inflammations. Timely diagnosis, cancellation of the drug that caused uveitis and appointment of adequate anti-inflammatory therapy in most cases effectively stops the symptoms of the disease, which determines the relevance of attention to the prevalence, pathogenesis, diagnosis and treatment of drug-induced uveitis.

EP33 Sjögren’s and lymphoproliferative disorders

Case report - IntroductionSjögren’s syndrome (SS) is a chronic autoimmune inflammatory condition characterised by lymphocytic infiltration of predominantly exocrine glands as well as other organs involving more commonly in skin, lungs, and neurological system. It is associated with increased risk of both benign and malignant lymphoproliferative disorders.Case report - Case descriptionA 29-year-old woman with 5-year history of Primary SS (ANA, Ro/La positive) was reviewed in a routine follow up. She has mild dry eyes, intermittent vasculitic rash around the ankles, occasional pleuritic chest pain but no cough or dyspnoea initially. She used artificial tears but took no regular mediations. Oxygen saturation at rest was 99% and BP 127/70. Heart sounds were normal, and chest was clear.Blood results showed alanine transaminase (ALT) had risen from 50 (normal 5-45) to 145 over 6 months. Viral screen (hepatitis, HIV, CMV, EBV) and liver ANA panel were negative. C4 was low 0.09 (n 0.15-0.55), C3 normal and DsDNA antibodies 1 (n 0-15.1). Ig G was high, fluctuating between 27 - 33 (n 7.67-15.9). ESR had been mildly elevated at 26 (n 0-19). CRP had always been within normal limits. Ultrasound abdomen showed enlarged spleen (15 cm). CT chest abdomen and pelvis showed multifocal groundless opacification affecting mid to upper zones, bilateral cyst formation, solid nodularity, and mild septal thickening with no pleural effusion. There were multiple prominent bilateral axillary and mediastinal lymph nodes measuring upto15 mm. The spleen measured 15.4 cm. Six months later, she developed mild dyspnoea on exertion. Examination revealed fine basal crackles. Oxygen saturation remained 99% at rest. TLco was mildly reduced and Kco in lower limit of normal. Echocardiogram was normal. Ultrasound guided core biopsy of axillary lymph node showed benign reactive features with follicular hyperplasia and plasmacytosis.The diagnosis of lymphocytic interstitial pneumonitis was made. She was started on a reducing dose of Prednisolone 30 mg and Mycophenolate stepwise increment to 1 gm BD. Chest pain resolved shortly after starting glucocorticoid therapy and exercise tolerance improved.Liver enzyme normalised. Case report - DiscussionThe diagnosis of lymphocytic interstitial pneumonia (LIP) in this patient was incidental from the retrospective investigation of the persistently abnormal unexplained liver function test. Splenomegaly is a recognised manifestation of active systemic SS. The main differential diagnoses are lymphoma and other types of interstitial lung diseases (ILD). Her presentation was insidious and there were no constitutional symptoms. Her ANA, Ro, La and Rheumatoid factor were strongly positive. She has hypergammaglobulinemia which is commonly associated with LIP. Histological findings were typical reactive changes with characteristic polymorphic plasmacytosis. In the absence of malignant lymphoid cells and radiological features of ground glass changes and bilateral cysts formation suggested that the most likely diagnosis was LIP secondary to primary SS.The management strategies vary for different types of ILD based on their etiological conditions. There are no specific guidelines for the treatment of LIP. For initial acute stage, glucocorticoid therapy is usually prescribed for symptomatic improvement. For later stages and cysts, immunosuppressants are used and depending on the severity, azathioprine, cyclosporin, rituximab and cyclophosphamide have been used.Median survival for LIP is 11.2 years. Increased risk of secondary infection because of immunosuppressive therapy is common and there are recommendations for atypical chest infection prophylaxis.Case report - Key learning pointsInterstitial lung disease is commonly associated with SS and predicts a higher mortality rate.Glucocorticoid is the main stay of treatment for ILD acute stage with active inflammatory changes.For refractory cases and chronic cystic stages on radiological findings, further immunosuppression therapy may be required.Standardised treatment guidelines are not available.Secondary chest infections may be seen in those with cystic disease and on immunosuppression.Close monitoring and MDT approach is required in the management of LIP.LIP may transform into lymphoma or co-present with lymphoma associated with SS.

Active inflammatory changes around the pubic symphysis in patients with axial spondyloarthritis: Magnetic resonance imaging characteristics and association with clinical factors

PurposeTo determine the prevalence of active inflammatory changes around the pubic symphysis on MRI scans in patients with axial spondyloarthritis, and to evaluate its association with clinical factors. MethodA retrospective analysis of MRI scans of 128 patients clinically diagnosed with axial spondyloarthritis was performed to assess the presence of active inflammatory changes around the pubic symphysis (bone marrow edema/osteitis and enthesitis). The clinical factors of the patients with and without active inflammatory changes around the pubic symphysis were compared. ResultsMRI scans showed active inflammatory changes around the pubic symphysis in 23 patients (18.0 %); 9 patients showed bone marrow edema/osteitis in the parasymphyseal pubic bone without soft tissue changes, 9 patients showed enthesitis with bone marrow edema/osteitis, and 5 patients showed enthesitis without bone marrow edema/osteitis. The median age of patients with active symphysis pubis changes was higher than that of those without active symphysis pubis changes (p < 0.001). C-reactive protein level and erythrocyte sedimentation rate in the active symphysis pubis group were both higher than those of the non-active symphysis pubis group (p = 0.001 and <0.001, respectively). ConclusionsActive inflammatory changes around the pubic symphysis were seen in 18.0 % of the patients diagnosed with axial spondyloarthritis undergoing pelvic MRI, and were associated with older age and elevated acute phase proteins.

Behcet's disease concurrent with axial spondyloarthritis: the authors' own observations

Objective : to present cases of Behcet's disease (BD) concurrent with axial spondyloarthritis (axSpA). Subjects and methods . A total of 470 patients with BD who met the International Standard Bibliographic Description (ISBD) criteria were examined at the V.A. Nasonova Research Institute of Rheumatology in the period from 1990 to 2018. In 9 of them, BD was concurrent with axSpA; 7 out of the 9 patients met the 1984 modified New York criteria for ankylosing spondylitis (AS) and two patients fulfilled the 2009 ASAS non-radiographic axSpA criteria. Results and discussion . Most (55.6%) patients were men. BD was preceded by axSpA in 6 patients. The symptoms of AS joined an average of 8.4 [2; 10] years after the onset of the clinical manifestations of BD. Three patients developed BB 9–15 years after the onset of the first symptoms of axSpA. The mean duration of BD was 14.0±7.8 years and that of axSpA was 10.9±6.2 years. All the patients were HLA-B27-positive; three were found to have B5 antigen. All the 9 patients had mucocutaneous manifestations that were characteristic of BD. Four patients were diagnosed as having eye injuries: generalized uveitis with retinal vasculitis, posterior uveitis with or without retinal vasculitis. Gastrointestinal tract lesions were detected in 44.4% of cases. Peripheral arthritis was present in all the patients. Entheseal involvement was observed in 66.7% of patients. The radiographic signs of bilateral sacroiliitis according to the modified New York criteria were found in 7 (77.8%) patients; MRI revealed active inflammatory changes in the area of the sacroiliac joint in 3 (33.3%) patients. Conclusion . The fact that there may be an overlap between BD and axSpA should be taken into account in everyday clinical practice, which will assist in choosing the optimal treatment strategy.

Dynamic changes of heart structural and functional condition in patients with acute myocarditis

Diagnosis and prognosis of myocarditis course, which is an inflammatory heart muscle disease, has been and remains one of the most urgent, complex and unresolved problem in modern cardiology. The purpose of the study – to investigate the dynamic changes in the structural and functional heart state in patients with acute myocarditis and reduced left ventricular ejection fraction. Materials and methods. In total, 74 patients with clinically suspected acute myocarditis (AM) with reduced left ventricular (LV) ejection fraction (EF) ≤40 % and NYHA heart failure (HF) functional class II or higher were examined three times: in the first month of myocarditis debut, after 6 and 12 months of observation. All the patients underwent echocardiography and speckle-tracking echocardiography, Holter electrocardiogram monitoring and cardiac magnetic resonance imaging (MRI). Results. It was found that the debut of AM was characterized by the presence of active inflammatory process according to the cardiac MRI - edema and hyperemia of the myocardium were detected in 54.0 % and 70.2 % of cases, respectively, followed by LV dilation and systolic dysfunction as well as by a significant decrease in longitudinal and circumferential LV global systolic strain. After 12 months of observation, there was a significant increase in LV EF, decrease in end-diastolic volume index and an improvement in the parameters of longitudinal and circumferntial LV systolic strain by 30.8 % and 36.8 %, respectively, (P < 0.01), the frequency of active inflammatory changes in the myocardium was significantly reduced, herewith in 41.8 % of cases, delayed enhancement was noted, indicating fibrotic changes in the myocardium. The presence of delayed enhancement in cardiac MRI after 12 months since myocarditis onset was correlated with the presence of unstable ventricular tachycardia episodes (r = 0.62; P < 0.02) and with the frequency of ventricular extrasystoles (r = 0.53; P < 0.05). A significant influence of fibrotic changes in the myocardium on the presence of unstable ventricular tachycardia episodes in 12 months after the disease onset was confirmed by determining Fisher's exact test, its value was: P = 0.016 (P < 0.05). Conclusions. It was established that the debut of myocarditis was characterized by a significant violation of the structural and functional heart state: an active inflammatory process in the myocardium causedLV dilatation and contractile dysfunction. After 12 months, a decrease in detection of active inflammatory myocardial changes followed by regression ofLV dilation and its contractile function improvement was observed. It was proved that the presence of fibrotic changes in the myocardium in patients with myocarditis was associated with the persistence of ventricular rhythm disorders.

MR distribution of active inflammatory and chronic structural sacroiliac joint changes in axial spondyloarthropathy: Challenging conventional wisdom

ObjectiveEvaluate the MR distribution of inflammatory sacroiliac joint changes in axial spondyloarthritis phenotypes, including Ankylosing Spondylitis (AS) and non-radiographic Axial Spondyloarthritis (nrAxSpA). MethodsA retrospective review of 94 patients seen for treatment of axial spondyloarthritis (SpA) who underwent sacroiliac joint MRI between January 2011 and December 2015 was performed. MR images from 68 patients (20 with AS and 48 with nrAxSpA) were reviewed independently by two radiologists. Images were scored on presence of active inflammatory and chronic structural lesions. These lesions were further categorized as unilateral, bilateral and asymmetric, or bilateral and symmetric. ResultsNo statistically significant difference was found in the distribution (laterality or symmetry) of bone marrow edema or sclerosis between the AS and nr-axSpA groups. Osseous erosions were more commonly bilateral symmetric in AS than nr-axSpA (11/20 vs. 8/48, p = 0.01). No statistically significant difference was noted between bone marrow edema scores in the AS and nr-axSpA subgroups (2.6 vs 3.3, p = 0.514). Patients with AS had a significantly higher fat metaplasia score compared to patients with nr-axSpA (7.3 vs 1.1, p = 0.001). Patients with nr-axSpA had a higher mean score for erosions (11.6 vs 4.2, p = 0.001). Only patients classified as AS were found to have bony ankylosis. Inter-observer reliability was strong to excellent. ConclusionAnkylosing spondylitis findings at the sacroiliac joints are classically described as bilateral and symmetric on radiographs. Our study demonstrates that distribution on MRI at an individual time point is variable. The variable distribution should be considered when radiologists evaluate MRI exams of AS patients.

Progression of Structural Damage in the Sacroiliac Joints in Patients With Early Axial Spondyloarthritis During Long-Term Anti-Tumor Necrosis Factor Treatment: Six-Year Results of Continuous Treatment With Etanercept.

To evaluate radiographic progression in the sacroiliac (SI) joints and to identify its predictors during long-term treatment (up to 6 years) with the tumor necrosis factor (TNF) inhibitor etanercept in patients with early axial spondyloarthritis (SpA). Patients with early axial SpA who were treated with etanercept for up to 6 years in the Etanercept versus Sulfasalazine in Early Axial Spondyloarthritis (ESTHER) trial were selected based on the availability of radiographs of the SI joints. Two readers who were blinded with regard to clinical data scored the radiographs according to the modified New York criteria (range 0-4 per SI joint). A sacroiliitis sum score (total range 0-8) was calculated as the mean of the scores of the 2 readers. Active and chronic inflammatory changes in the SI joints on magnetic resonance imaging (MRI) performed at baseline, year 2, and year 4 were assessed according to the Berlin MRI scoring system. Of the 76 patients originally included in the study, 42 had radiographs of the SI joints available at baseline and at least 1 follow-up time point (year 2, 4, or 6). The mean ± SD change in the sacroiliitis sum score was 0.13 ± 0.73, -0.27 ± 0.76, and -0.09 ± 0.68, in the time intervals baseline to year 2, year 2 to year 4, and year 4 to year 6, respectively. In the longitudinal mixed model analysis, elevated C-reactive protein level (β = 0.58 [95% confidence interval 0.24, 0.91]) and MRI SI joint osteitis score (β = 0.06 [95% confidence interval 0.03, 0.10]) were independently associated with progression of the sacroiliitis sum score. Our findings indicate that long-term anti-TNF therapy decelerates the progression of structural damage in the SI joints. Elevated CRP level and presence of osteitis on MRI were independently associated with radiographic sacroiliitis progression.

Ultrasound-MRI Fusion for Targeted Biopsy of Myopathies.

OBJECTIVE. The purpose of this article is to describe the use of ultrasound-MRI fusion imaging to guide precise and targeted muscle biopsy in patients with suspected myopathies. CONCLUSION. Ultrasound-MRI fusion-guided muscle biopsy allows targeted sampling of tissues with active inflammatory changes and facilitates diagnosis of myopathies.

Study of glucocorticoid therapy efficiency in patients with chronic myocarditis

One of the most urgent issues of non-coronary heart disease remains the expediency of prescribing immunosuppressive therapy with glucocorticoids (GC) in patients with chronic myocarditis. The purpose of the study was to perform a comparative analysis of the structural and functional heart state in patients with chronic myocarditis who received or did not receive glucocorticoid therapy. The study included 58 patients with chronic myocarditis with reduced left ventricular ejection fraction (LV) and presence of II or higher functional class of heart failure according to New York Heart Association criteria, which were divided into 2 groups: the 1st group consisted of 30 patients who, in addition to standard heart failure therapy, were treated with methylprednisolone 0.5 mg/kg for 4 months with a gradual subsequent dose reduction, and the 2nd group included 28 patients who did not receive immunosuppressive therapy. All patients underwent for a 6-minute walk test, echocardiography with speckle-tracking and cardiac magnetic resonance imaging (CMR). The examination was carried out before the appointment of the GC and after 6 months of treatment. For statistical processing of the results, the software Exсel XP (Missrosoft Office, USA) and statistical program Statistica for Windows 6.0 (Statsoft, USA) were used. Prior to treatment, both groups were comparable to the results of a 6-minute walk test and all echocardiographic parameters, inflammatory and fibrotic changes in the myocardium were detected with approximately same frequency. After 6 months of GC therapy, it was found that the end-diastolic volume index in the 1st group was 17.5% (P &lt;0.05) less and value LV ejection fraction was 13.5% (P &lt;0.05) higher in comparison with the 2nd group, in addition the value of global longitudinal systolic strain was also 27.5% (P &lt;0.01) higher in the 1st group. The frequency of active inflammatory changes detection on CMR - myocardial edema and hyperemia in the 1st group after 6 months was 16.6% and 20.0% respectively, that presented as almost twice lower than in the 1st group; fibrotic changes in the myocardium in 1st group were observed in 66.6% of cases, which was 1.7 times more frequent than in the 2nd group. Significant influence of the appointment of immunosuppressive therapy on the absence of inflammatory changes in the myocardium was confirmed by correlation analysis: the use of GC was associated with the absence of edema and myocardial hyperemia after 6 months of treatment - (r = -0,82; P &lt;0,01) and (r = -0.76; P &lt;0.01) respectively. In patients with chronic myocarditis receiving immunosuppressive therapy, inflammatory changes in the myocardium (edema and hyperemia) were found to be much less common, the end diastolic volume index was significantly lower, LV ejection fraction and parameters of longitudinal global systolic strain were higher in comparison with patients who did not receive GC treatment.

Опрацювання нових підходів до діаґностики дифузного міокардиту та дилатаційної кардіоміопатії

Aim.&nbsp;To develop new approaches to the diagnosis of diffuse myocarditis and dilated cardiomyopathy based on the study of immune state as well as structural and functional heart condition. Materials and Methods.&nbsp;The 94 studied patients were divided into 2 groups: the 1st group - 52 patients with chronic diffuse myocarditis and the 2nd group - 42 patients with dilated cardiomyopathy. All patients presented with left ventricular systolic dysfunction - ejection fraction Ј40% and heart failure functional class II or worse. We studied serum levels of mean myocardial antibody titer, immunoglobuline M and G concentrations, blasttransformation lymphocyte activity, and concentrations of СD8+, СD16+ and СD19+ lymphocytes. The heart failure functional class was determined by the 6-minute walk test. By the use of 2D-echocardiography and speckle-tracking we measured left ventricular end-diastolic, end-systolic volume index and ejection fraction as well as the global longitudinal, circumferential, radial systolic strain. Cardiac magnetic resonance imaging with late enhancement was performed in all patients.&nbsp; Results and Discussion.&nbsp;Both study groups were comparable according to the severity of clinical manifestations of heart failure on the results of a 6-minute walk test and left ventricular ejection fraction, which was on average (34,6±2,5)% in the 1st and (32,8±2,7)% in the 2nd group (P&gt;0.05). However, the frequency of myocardial antibodies detection in the 1st group was 53,1%, while in the 2nd group it was 23,3%, the average titer of myocardial antibodies and the activity of the lymphocyte blasttransformation reaction in the group of patients with myocarditis were higher by 21,4% (P&lt;0.05) and 43,3% (P&lt;0.01) respectively, compared with those in dilated cardiomyopathy. The analysis of speckle-tracking echocardiography results showed that in patients with dilated cardiomyopathy parameters of longitudinal and circumferential global systolic strain of the left ventricle were significantly lower compared with those in patients with myocarditis, on average, 45,2% (P&lt;0.01) and 40,2% (P&lt;0.05) respectively. According to the results of magnetic resonance imaging, it was found that myocarditis is characterized by active inflammatory changes in the myocardium, while in dilated cardiomyopathy we did not observe inflammatory changes and 94,2% of patients presented with diffuse fibrosis of the heart muscle.&nbsp; Conclusions.&nbsp;In patients with myocarditis, dilatation and systolic dysfunction of the left ventricle were induced by an active inflammatory process in the myocardium, which according to the correlation analysis was associated with the activation of immunopathological reactions of cellular and humoral immunity and confirmed by the results of cardiac magnetic resonance imaging. Dilated cardiomyopathy is characterized by the low activity of immunopathological reactions of cellular and humoral immunity; diffuse fibrotic changes in the myocardium, which cause dilatation and systolic left ventricular dysfunction; and by a significant decrease in the parameters of longitudinal and circumferential global systolic strain of the left ventricle compared to those in patients with myocarditis.&nbsp

Classification Terminology and Definitions in Reporting of MRI in Axial Spondyloarthritis.

Spondyloarthritis (SpA) is a group of chronic inflammatory conditions which severely impact quality of life. Several criteria have been developed in the past to aid the diagnosis of SpA based on symptoms and radiographic changes during the course of the disease. However, it takes several years before structural changes manifest on conventional radiographs, leading to a diagnostic delay of 6 to 10 years. The use of MRI and its incorporation into the Assessment of Spondyloarthritis (ASAS) criteria, has radically changed the diagnosis of SpA in the last decade by allowing visualisation of both active and chronic inflammatory changes and enabling clinicians to recognise SpA during it’s early stage and initiate treatment. An understanding of the various terminology used in the divisions of disease presentations and their relevant imaging findings are key, along with the use of clear definitions of structural and inflammatory changes on MRI, in ensuring accurate diagnosis and classification of SpA.

Infections of the Spine and Spinal Cord in Children

AbstractInfection of the spine and spinal cord are uncommon in children which if not diagnosed and treated early in the course of disease can lead to spinal instability and devastating neurological outcome. The spectrum of spinal infection ranges from discitis/osteomyelitis, spinal epidural abscess, subdural abscess, spinal meningitis, arachnoiditis, neuritis, myelitis, and intramedullary abscess. Inability of the children to express themselves and nonspecific clinical features like abdominal pain, walking/crawling difficulty, and fever can result in difficult and delayed diagnosis. Imaging plays a critical role in diagnosis of spinal infection; its complication and treatment follow-up. Magnetic resonance imaging with gadolinium contrast is considered as the imaging modality of choice for evaluation of spinal and cord infections. Infectious mimics like chronic recurrent multifocal osteomyelitis, pars articular defect with active inflammatory changes, spondyloarthritis, Guillain-Barre syndrome, transverse myelitis, acute disseminated encephalomyelitis, and multiple sclerosis can pose diagnostic challenge on imaging. The aim of this article is to briefly review the imaging appearances of infection involving various spinal compartments, pattern of infection spread, its complications and various mimics.

Serum ACE Level in Sarcoidosis Patients with Typical and Atypical HRCT Manifestation.

SummaryBackgroundSarcoidosis is an inflammatory disease that affects multiple organs. Before widespread use of computed tomography (CT), the severity of sarcoidosis was assessed based on chest X-ray abnormalities. HRCT can distinguish between active inflammatory changes and irreversible fibrosis. In this study, we analyzed different ACE levels in 148 patients diagnosed with sarcoidosis.Material/MethodsWe categorized these patients based on their HRCT results into four groups: 1) patients diagnosed with chronic disease; 2) patients diagnosed with non-chronic disease; 3) patients who exhibited typical HRCT changes; and 4) patients who exhibited atypical HRCT changes. Afterward the mean ACE level of each group was calculated and compared.ResultThe HRCT scans of chronic sarcoidosis patients tended to show more atypical sarcoidosis patterns. Moreover, there was a reverse correlation between chronicity and ACE level (P-value <0.05).ConclusionsHRCT is another modality which would be useful when the diagnosis of sarcoidosis is not definite.

Spectrum of Inflammatory Changes in the SIJs on Radiographs and MR Images in Patients with Suspected Axial Spondyloarthritis.

SummaryBackgroundThe aim of the paper was to compare radiographs and MRI in assessment of active and chronic inflammatory changes in the sacroiliac joints in patients with chronic back pain and suspected axial spondyloarthritis.Moreover, the aim was to determine which of the two methods is more accurate in diagnosing individual inflammatory changes in the sacroiliac joints and whether there is a correlation between radiographs and MRI in their identification.Material/MethodsThe analysis was conducted in a group of 101 patients, including 61 women and 40 men, referred to radiographs and MR examinations by rheumatologists due to chronic back pain.AP images of the lumbar region of the spine were performed in each patient in the supine position. The images included the sacroiliac joints. Changes in the SIJs were assessed based on the New York criteria of 1966. In MR examination, the SIJs were assessed in terms of the presence of active and chronic inflammatory changes described by the ASAS. The statistical analysis of the variables tested was conducted in the Excel and Statistica systems.ResultsIn relation to the final clinical diagnosis of axSpA, MRI had higher sensitivity and specificity than radiography in diagnosing sacroiliitis (sensitivity: 71% vs. 22%, specificity: 90% vs. 94% on radiographs according to New York criteria. In relation to MRI, radiographs resulted in 40% of incorrect sacroiliitis diagnoses (both false positive and false negative results). In as many as 50% of cases (7/14), MRI failed to confirm the presence of inflammatory changes in the sacroiliac joints observed in radiography according to the modNY criteria (false positive results on radiographs).Both examinations are characterised by very low agreement, which is near to random, in assessing individual features of sacroiliitis, such as sclerosis, change in the joint space width, erosions and ankylosis.Conclusions1. Radiographs do not allow early inflammatory lesions indicating sacroiliitis to be diagnosed, which leads to diagnostic delay. MRI is the method of choice in diagnosing early sacroiliitis and detecting structural lesions, in particular sclerosis and erosions. 2. Radiographs and MRI are characterised by low, near to random, agreement in the detectability of the individual inflammatory changes in the sacroiliac joints.