Assessment Of Inflammatory Activity Research Articles

Evaluation and comparison of capsule endoscopy scores for assessment of inflammatory activity of small-bowel in Crohn's disease

IntroductionCapsule endoscopy (CE) has the highest sensitivity in the evaluation of small-bowel mucosa in Crohn's disease (CD). Recent guidelines recommend the use of validated CE scores to assess small-bowel inflammatory activity in CD. Lewis score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) are the currently available validated scores, but comparative studies are scarce. Moreover, correlation of these endoscopic scores with biomarkers and clinical activity is lacking. This study aims to compare LS with CECDAI, to determine cutoff values for CECDAI similar to those of LS (135–790), and to correlate LS and CECDAI with biomarkers and symptoms. StudyAll patients with CD who underwent CE between March/2010 and February/2016 were included. LS and CECDAI were determined after analysis of each CE. In patients with small-bowel CD, C-reactive protein (CRP) and Harvey–Bradshaw index (HBI) were evaluated. Statistical analysis: descriptive statistics, Spearman's correlation coefficient and linear regression analysis. Significance: p<0.05. ResultsFifty-three patients were included and the mean values obtained for LS were 1147±1453, CECDAI 11.3±6.9, CRP 0.92±1.5mg/dL and HBI 2.4±2.8. There was a very strong correlation between LS and CECDAI (rs=0.878; p<0.0001) and thresholds values of 135–790 in LS corresponded to 7.7–10.3 cutoff values in CECDAI, respectively. Neither CRP correlated with LS (rs=0.068; p=0.72) or CECDAI (rs=−0.004; p=0.98), nor HBI with LS (rs=−0.15; p=0.40) or CECDAI (rs=−0.10; p=0.23). ConclusionCorrelation between the two CE activity scores was very strong, with LS thresholds of 135–790 corresponding to CECDAI values of 7.7–10.3. HBI and CRP had no correlation with CECDAI and LS.

A Non-Peptidic S100A9 Specific Ligand for Optical Imaging of Phagocyte Activity In Vivo.

Non-invasive assessment of inflammatory activity in the course of various diseases is a largely unmet clinical challenge. An early feature of inflammation is local secretion of the alarmin S100A8/A9 by activated phagocytes. We here evaluate a novel S100A9-targeted small molecule tracer Cy5.5-CES271 for in vivo optical imaging of inflammatory activity in exemplary disease models. Dynamics of Cy5.5-CES271 was characterized in a model of irritant contact dermatitis by sequential fluorescence reflectance imaging (FRI) up to 24h postinjection (p.i.). Specificity of Cy5.5-CES271 binding to S100A9 in vivo was examined by blocking studies and by employing S100A9-/- mice. Finally, S100A9 secretion in acute lung inflammation was assessed by Cy5.5-CES271 and FRI of explanted lungs. In ear inflammation, we were able to non-invasively follow the time course of S100A9 expression using Cy5.5-CES271 and FRI over 24h p.i. (peak activity at 3h p.i.). Specificity of imaging could be shown by a significant signal reduction after predosing and using S100A9-/- mice. In acute lung injury, local and systemic S100A8/A9 levels increased over time and correlated significantly with FRI signal levels in explanted lungs. Cy5.5-CES271 shows significant accumulation in models of inflammatory diseases and specific binding to S100A9 in vivo. This study, for the first time, demonstrates the potential of a small molecule non-peptidic tracer enabling imaging of S100A9 as a marker of local phagocyte activity in inflammatory scenarios suggesting this compound class for translational attempts.

Quantitative Metabolic Volumetric Product on 18Fluorine-2fluoro-2-deoxy-D-glucose-positron Emission Tomography/Computed Tomography in Assessing Treatment Response to Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis: Multiparametric Analysis Integrating American College of Rheumatology/European League Against Rheumatism Criteria.

The purpose of this study was to assess the role of fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the evaluation of treatment response evaluation to disease-modifying antirheumatic drug (DMARD) therapy in patients of rheumatoid arthritis (RA). A total of ten patients with proven diagnosis of RA as per the 2010 American College of Rheumatology/European League against Rheumatism (EULAR) criteria were prospectively evaluated. All patients underwent clinical and biochemical evaluation and a baseline FDG-PET/CT with assessment of maximum standardized uptake value and metabolic volumetric product (MVP) values. DMARD therapy was started with a combination of hydroxychloroquine and sulfasalazine. On follow-up at 3 and 6 months, the response to treatment was assessed by clinical, biochemical, and FDG-PET/CT parameters. These parameters were analyzed in a combined manner, and the patients were grouped into 4 categories as per response to DMARD therapy - complete response, good response, mixed response, and no response. Evaluation of treatment response in ten patients at 3rd month and in nine patients at 6 months showed (a) agreement for MVP, biochemical parameters with clinical symptomatic assessment in all patients, (b) while agreement for EULAR score was noted in only three patients and disagreement in seven patients with clinical symptoms Response EULAR (rEULAR) (0.37) and at 6 months in only three patients and disagreement in six patients, rEULAR (0.52). The correlation factors at 3rd month and 6th months were, respectively, as follows: rMVP (0.67 and 0.75), response RA factor (0.54 and 0.74), response erythrocyte sedimentation rate (0.81 and 0.73), response C-reactive protein (0.78 and 0.51), and response anti-cyclic citrullinated peptide antibodies (0.33 and 0.54). The overall response to DMARD therapy at 3 months was assessed with results showing good response by four cases (40%), mixed response by 1 (10%), no response by 5 (50%), and complete response by none (0%). Step-up therapy at 3 months was initiated in four patients showing nonresponse/progression on clinical symptomatic assessment; of these, two patients showed a good response, one mixed response, and the remaining one continued to show nonresponse at 6 months follow-up. One patient who had a minimal response at 3 months on PET-CT (only 5.96% reduction of MVP) was continued on the same DMARD in view of clinical symptomatic good response (at 3 months) but ultimately had disease progression in all scales and worsening of symptom (at 6 months). FDG-PET/CT-based assessment of inflammatory activity noted in the joints of RA with quantitative parameters can be a promising approach for the whole body assessment of RA disease activity and treatment response assessment, especially in inconclusive cases and correlates well with other parameters. MVP can be used as a useful objective and adjunct parameter for assessing response to treatment.

Lipocalin-2 is expressed by activated granulocytes and keratinocytes in affected skin and reflects disease activity in acne inversa/hidradenitis suppurativa.

Acne inversa (AI)/hidradenitis suppurativa is a chronic inflammatory disease characterized by painful axillary, inguinal and perianal skin lesions with deep-seated nodules, abscesses and fistulae. This study aimed to identify and characterize the key players in AI pathogenesis. Epidemiological and anamnestic data for patients with AI were collected, and blood and skin samples were also taken. Healthy participants and patients with psoriasis served as controls. Assessment of samples and cultures of primary cells was performed by enzyme-linked immunosorbent assay, quantitative polymerase chain reaction on reverse transcribed mRNA, and immunohistochemistry. Of 35 mediators quantified in the blood of patients with AI, lipocalin-2 (LCN2) appeared as one of the most significantly upregulated parameters compared with healthy participants [85·8 ± 12·2 (n = 18) vs. 41·8 ± 4·2 (n = 15); P < 0·001]. Strongly elevated LCN2 expression was present in AI lesions, with granulocytes and keratinocytes being sources of this expression. In vitro, these cells upregulated LCN2 production in response to tumour necrosis factor (TNF)-α, and a positive relationship between systemic TNF-α and LCN2 levels (rs = 0·55, P = 0·011; n = 20) was evident for AI. LCN2 blood levels correlated with AI disease severity (rs = 0·65, P < 0·001; n = 29), but not with disease duration, age, sex, body mass index or smoking habit. Detailed analyses revealed a link with the number of skin regions containing nodules and fistulae, but not scars. LCN2 might serve as a blood biomarker for the objective assessment of inflammatory activity in AI. We suggest a self-amplification loop comprising TNF-α, neutrophilic granulocytes and LCN2, which contributes to the recurrent skin neutrophil infiltration in AI, clinically evident as pus.

Serum Calprotectin in Rheumatoid Arthritis: A Promising Diagnostic Marker, How Far Is It Related to Activity and Sonographic Findings?

BackgroundIn the past 2 decades, there has been increasing interest in calprotectin. It is released and detected in serum and body fluids as a potentially useful clinical inflammatory marker. The protein has been described in synovial tissue in rheumatoid arthritis (RA) patients, specifically in the lining layer adjacent to the cartilage–pannus junction, which is the primary site of cartilage destruction and bone erosion. Assessment of inflammatory activity in RA is of pivotal importance for the optimal treatment. Our aim in this study is to measure the serum calprotectin levels in RA patients and to assess its association—if there is any—with disease activity score and radiological findings using the musculoskeletal ultrasound. Patients and methodsIn our case control study, we included 44 RA patients (Group I) and 20 age- and sex-matched healthy volunteers who served as the control group (Group II). Both groups were subjected to full history taking and thorough clinical examination. Assessment of RA disease activity state was done for all RA patients using the Disease Activity Score 28. Laboratory investigations included the measurement of complete blood cell count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anticitrullinated peptide antibodies, kidney, liver functions; serum calprotectin levels were determined using enzyme-linked immunosorbent assay and radiological joint assessment was done using musculoskeletal ultrasound score. ResultsThere was a statistically significant elevation of serum calprotectin levels among RA patients when compared with healthy controls. Statistically significant correlations were also found between serum calprotectin and the ultrasound grading score, Disease Activity Score 28, and erythrocyte sedimentation rate, which reflect the degree of inflammatory activity in the affected joints in RA patients. Moreover, the study yielded a significant correlation between serum calprotectin levels and rheumatoid autoantibodies (rheumatoid factor and anticitrullinated peptide antibodies), which are strong predictors of the aggressiveness of the disease. Serum calprotectin at a cutoff level of 93.9 μg/dL had 88.6% sensitivity and 100% specificity for diagnosis of RA. ConclusionCalprotectin was found to have high association with laboratory and ultrasonography markers of inflammation in RA patients, so it is recommended for use as a marker of inflammatory activity in RA patients especially for the follow-up of patients on biological therapy to assess its efficacy.

Валидность лучевых методов в оценке активности воспаления и фиброзной трансформации поджелудочной железы при хроническом панкреатите

Валидность лучевых методов в оценке активности воспаления и фиброзной трансформации поджелудочной железы при хроническом панкреатите

Urinary cytokines as markers of latent inflammation in children with chronic pyelonephritis and anorectal malformations

Anorectal malformations (ARMs) comprise a range of defects in the development of the lowest portion of the intestinal tract that are often associated with anomalies of the urinary tract. We hypothesize that ARMs may specifically predispose the patients to prolonged urinary tract infection (UTI) and transition from a state of active (clinically apparent) inflammation to a state of latent inflammation following antibiotic treatment. Yet diagnosis of latent inflammation in the urinary tract is problematic. The aim was to investigate the urinary levels of proinflammatory (IL-1β, IL-6, IL-8, and MCP-1), anti-inflammatory (IL-10), and proangiogenic (VEGF) cytokines in the clinical course of chronic pyelonephritis (CP) as potential biomarkers of latent inflammation in the urinary tract in children with ARM. A total of 34 children (age range 4-120 months) with CP in the active phase of inflammation were divided into two groups: CP with ARM group included 20 patients and CP without ARM group included 14 patients. The control group included 20 healthy children similar by age and gender. Urine samples were collected at the time of enrollment, 5-7 days after institution of antibiotic treatment, and 1.5 months after enrollment. Cytokine concentrations were measured by ELISA. Upon enrollment, we detected increased urinary levels of IL-10 and MCP-1 and normal levels of IL-1β, IL-6, IL-8, and VEGF in CP with ARM patients as well as normal levels of all of these cytokines in CP without ARM patients. After 5-7 days of antibiotic treatment, despite significant clinical and laboratory improvement observed in both patient groups, we documented a prominent increase in the urinary concentrations of all measured cytokines indicating ongoing inflammation in the urinary tract. Following 1.5 months of enrollment, in CP without ARM patients, IL-8 and MCP-1 were increased, IL-1, IL-6, and VEGF were close to control, and IL-10 was below the control level, indicating partial resolution of the inflammatory process. In contrast, in CP with ARM patients, IL-1β, IL-6, IL-8, MCP-1, and VEGF were increased suggesting persistent inflammation in the urinary tract (Table). Based on the urinary cytokine profile, we conclude that presence of ARM may be associated with transition from active to latent inflammation in the urinary tract after antibiotic treatment for UTI. Follow-up monitoring of the urinary cytokines may provide a better assessment of inflammatory activity in the urinary tract in children with combined urological and anorectal pathologies.

Preclinical imaging of the co-stimulatory molecules CD80 and CD86 with indium-111-labeled belatacept in atherosclerosis.

BackgroundThe inflammatory nature of atherosclerosis provides a broad range of potential molecular targets for atherosclerosis imaging. Growing interest is focused on targets related to plaque vulnerability such as the co-stimulatory molecules CD80 and CD86. We investigated in this preclinical proof-of-concept study the applicability of the CD80/CD86-binding fusion protein belatacept as a probe for atherosclerosis imaging.MethodsBelatacept was labeled with indium-111, and the binding affinity was determined with CD80/CD86-positive Raji cells. In vivo distribution was investigated in Raji xenograft-bearing mice in single-photon emission computed tomography (SPECT)/CT scans, biodistribution, and ex vivo autoradiography studies. Ex vivo SPECT/CT experiments were performed with aortas and carotids of ApoE KO mice. Accumulation in human carotid atherosclerotic plaques was investigated by in vitro autoradiography.Results111In-DOTA-belatacept was obtained in >70 % yield, >99 % radiochemical purity, and ~40 GBq/μmol specific activity. The labeled belatacept bound with high affinity to Raji cells. In vivo, 111In-DOTA-belatacept accumulated specifically in Raji xenografts, lymph nodes, and salivary glands. Ex vivo SPECT experiments revealed displaceable accumulation in atherosclerotic plaques of ApoE KO mice fed an atherosclerosis-promoting diet. In human plaques, binding correlated with the infiltration by immune cells and the presence of a large lipid and necrotic core.Conclusions111In-DOTA-belatacept accumulates in CD80/CD86-positive tissues in vivo and in vitro rendering it a research tool for the assessment of inflammatory activity in atherosclerosis and possibly other diseases. The tracer is suitable for preclinical imaging of co-stimulatory molecules of both human and murine origin. Radiolabeled belatacept could serve as a benchmark for future CD80/CD86-specific imaging agents.Electronic supplementary materialThe online version of this article (doi:10.1186/s13550-015-0157-4) contains supplementary material, which is available to authorized users.

Perfusion-based assessment of disease activity in untreated and treated patients with aortitis and chronic periaortitis: correlation with CT morphological, clinical and serological data.

To evaluate the role of perfusion-based assessment of inflammatory activity in patients with treated and untreated aortitis and chronic periaortitis as compared with clinical and serological markers. 35 patients (20 females; median age 66 years) with (peri) aortitis were retrospectively evaluated. All patients had clinical symptoms prompting at the time of imaging. All patients first underwent whole-body contrast-enhanced CT and subsequently segmental volume perfusion CT for assessment of the degree of vascularization of (peri) aortitis as a surrogate marker for inflammatory activity. Blood flow, blood volume, volume transfer constant (k-trans), time to peak and mean transit time were determined. The thickness of the increased connective tissue formation was measured. Perfusion data were correlated with clinical symptoms and acute-phase inflammatory parameters such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte number. 21 of 35 patients were untreated and 14 of 35 had previous/ongoing immunosuppression. The interobserver agreement was good (κ = 0.78) for all perfusion parameters. Average values of perfusion parameters were higher in untreated patients but remained abnormally elevated in treated patients as well. Perfusion data and ESR and CRP correlated well both in aortitis (p < 0.05) and in periaortitis (p < 0.05). In periaortitis, perfusion parameters agreed well with ESR and CRP values (p < 0.05) only in untreated patients. Perfusion CT parameters in untreated aortitis and chronic periaortitis correlate well with serological markers with respect to disease activity assessment. However, in treated periaortitis, correlations were weak, suggesting an increased role for (perfusion-based) imaging. Volume perfusion CT may be used for diagnosis of aortitis/periaortitis.

Impact of gadolinium-based contrast agent in the assessment of Crohn's disease activity: Is contrast agent injection necessary?

To determine whether magnetic resonance enterography (MRE) performed without intravenous contrast injection is diagnostically noninferior to conventional contrast-enhanced MRE (CE-MRE) in patients with Crohn's disease (CD). This was an Institutional Review Board (IRB)-approved retrospective study. Ninety-six patients (52 male and 44 female; 47.18 years ± 13.6) with a diagnosis of CD underwent MRE at 1.5T including T2 -weighted single-shot turbo-spin-echo, T2 -weighted spectral fat presaturation with inversion recovery (SPAIR), T1 -weighted balanced fast-field-echo MR sequences, and CE-MRE consisting in T1 -weighted breath-hold THRIVE 3D MRI sequences after administration of gadobenate dimeglumine (0.2 mL/kg of body weight). Unenhanced MRE, CE-MRE, and unenhanced MRE plus CE-MRE were reviewed in separate sessions with blinding by two readers in consensus, and subsequently by two other readers independently considering a subgroup of 20 patients. Crohn's Disease Endoscopic Index of Severity (CDEIS) and/or histologic analysis of the surgical specimen were considered as reference standards for the assessment of inflammatory activity. Patients revealed prevalently active (n = 55 patients) or quiescent CD (n = 41 patients). The agreement between unenhanced MRE vs. CE-MRE in interpreting active bowel inflammation was 96% (123/128 bowel segments; one-sided 95% confidence interval [CI], >94.4%). Unenhanced MRE vs. CE-MRE vs. unenhanced MRE plus CE-MRE revealed a diagnostic accuracy of 93% [90/96] vs. 92% [88/96] vs. 97% [93/96] (P > 0.05) in the diagnosis of active CD. Interreader agreement was very good for all variables (κ value = 0.8-0.9) except for the measurement of the length of disease (κ value = 0.45). Unenhanced MRE was noninferior to CE-MRE in diagnosing active inflammation in patients with CD.

Comparison of Photo Optical Imaging with Musculoskeletal Ultrasound and Clinical Examination in the Assessment of Inflammatory Activity in Proximal Interphalangeal Joints in Rheumatoid Arthritis and Osteoarthritis.

Lightscan is a novel, rapid, low-cost, easily operated and noninvasive imaging technology used to assess inflammatory activity in proximal interphalangeal (PIP) joints. The results are calculated automatically. To our knowledge, this is the first comparative study of photo optical imaging (POI), with clinical examination (CE), disease activity score at 28 joints (DAS28)-erythrocyte sedimentation rate (ESR), and musculoskeletal ultrasonography (US) in healthy subjects and patients with rheumatoid arthritis (RA) or osteoarthritis (OA). There were 688 PIP joints of both hands examined in 87 subjects (38 RA, 21 OA, 28 healthy) by Lightscan and compared with CE for clinically swollen and tender joints, DAS28-ESR (only RA), and US. With US as reference, POI had a sensitivity of 74% and a specificity of 93%. In the receiver-operating curve (ROC) analysis, the Lightscan showed a higher sensitivity and specificity [area under the curve (AUC) 0.879] for the distinction of healthy subjects versus patients (OA, RA) than US in greyscale (GSUS; AUC 0.797) and power Doppler (PDUS; AUC 0.67). POI correlated significantly with GSUS (r 0.473, p < 0.01) and PDUS (r 0.486, p < 0.01). The agreement rates between POI and GSUS were up to 79%, between POI and PDUS up to 92%, and between POI and CE up to 66%. POI did not correlate with DAS28-ESR. The Lightscan is a new technology offering sensitive imaging detection of inflammatory changes in subjects with RA and OA with PIP arthritis. POI was more sensitive than CE and correlated significantly to GSUS and PDUS, while presenting a higher sensitivity and specificity for the detection of healthy subjects versus patients (RA, OA) based on the ROC analysis.

The assessment of inflammatory activity and toxicity of treated sewage using RAW264.7 cells.

Toxicity and inflammatory activity of wastewater samples were evaluated using RAW264.7 cells as a bioassay model. The RAW264.7 cell cultures were exposed to sterile filtered wastewater samples collected from a sewage treatment plant. Cell viability was evaluated using WST‐1 and XTT assays. Inflammatory effects of samples were assessed by determination of nitric oxide (NO) and interleukin 6 (IL‐6). The NO was estimated using the Griess reaction and IL‐6 was measured by enzyme‐linked immunoassay. All samples had no toxicity effects to RAW264.7 cells, however they significantly (P < 0.001) induced NO and IL‐6 production. The highest NO (12.5 ± 0.38 μM) and IL‐6 (25383.84 ± 2327 pg/mL) production was induced by postbiofiltration sample. Final effluent induced the lowest inflammatory response, which indicates effective sewage treatment. In conclusion, wastewater samples can induce inflammatory activities in RAW264.7 cells. The RAW264.7 cells, therefore, can be used as a model for monitoring the quality of treated sewage.

PROVISION OF VITAMINS AND CALCIUM IN RHEUMATOID ARTHRITIS: ESTIMATION OF INTAKE AND PLASMA CONCENTRATIONS

Objective: to study the actual intake of vitamins and calcium and their provision in rheumatoid arthritis (RA) in the Middle Urals. Subjects and methods. The case-control method was used to form 150 pairs of RA patients aged 55.31±11.3 years. Their actual nutrition was studied from the frequency of food intake for a month, by applying a questionnaire. Based on the obtained food consumption data, the authors calculated the daily intake of vitamins A, B 2 , C, E, β -carotene, and calcium. The plasma levels of these factors were measured in 40% of the random patient sample and in 68 (45%) control persons. A complete clinical examination included the evaluation of patients' general health and articular status, inflammatory activity assessment with DAS28, laboratory tests (general blood and urine analyses, estimation of the levels of transaminases, creatinine, electrolytes, C-reactive protein, and rheumatoid factor), and instrumental examination, involving electrocardiography and joint X-ray. Results and discussion. The study demonstrated that actual nutrition was depleted of vitamins A, C, and B 2 in the patients with RA as compared to the controls. Inadequate provision of vitamin C, β -carotene, riboflavin, and calcium was found in RA. The inconsistency between the consumption of vitamins C, B 2 , and β -carotene and their plasma levels could suggest increased demands for these nutrients in RA. The findings should undergo detailed studies; first of all, this concerns the comparison of intake of the nutrients and their provision with the most important clinical characteristics of RA, such as duration, progression, activity, X-ray stage, and the presence of rheumatoid factor. The knowledge of these matters could, in our opinion, improve the results of therapy and prognosis in RA.

Development and validation of an endoscopic activity score for canine inflammatory bowel disease

The aim of this study was to develop and prospectively validate a simple endoscopic score of disease activity for dogs with inflammatory bowel disease (IBD). Archived endoscopic still images and video recordings of gastric, duodenal, and colonic endoscopic examinations were displayed to novice and experienced endoscopists for assessment of inflammatory activity using established descriptions. The mucosal appearances evaluated were normal tissue, erosions, friability, increased granularity, lymphangiectasia (duodenum), and mass (colon). Fleiss and Cohen's Kappa statistics were used to estimate the inter-observer agreement of the index.For duodenal assessment, there were statistically significant (P < 0.05) differences in inter-observer agreement, with experienced endoscopists performing better than novice endoscopists in the accurate identification of mucosal appearance of the duodenum. In contrast, there was no significant difference between novice and experienced endoscopists in their interpretation of gastric (P = 0.10) and colonic (P = 1.0) mucosal appearances. Validation studies using endoscopic video clips to assess the same endoscopic parameters by quantitative (lesion number and severity) and qualitative (presence of mucosal lesions) methods showed moderate-to-substantial agreement between experienced endoscopists. Based on the observations that the quantitative and qualitative scores of mucosal appearances are virtually identical, and that qualitative assessment was performed more quickly and objectively than quantitative assessment, we propose a simple endoscopic activity score based on qualitative criteria alone in dogs with inflammatory bowel disease.

Rheumatoid arthritis: A major symptom and symptomatic therapy

Pain is a major problem in patients with rheumatoid arthritis (RA). It produces a serious psychological discomfort, causes sleep disorders, and drastically limits physical activity. Pain is one of the main signs of inflammation and its intensity correlates with inflammatory activity. The early use of disease-modifying antirheumatic drugs, regular monitoring, and timely correction of therapy in accordance with the treat-to-target principle make it possible to effectively monitor the activity of RA and to delay its progression. However, despite a marked decrease in RA activity, pain does not go away completely and may increase with time in a number of cases. Pain occurring in patients with RA is always far short of being caused by arthritis. It may be also related to comorbidity, osteoarthritis or fibromyalgia in particular. Pain induced by comorbidity may seriously distort the result of assessment of inflammatory activity and a physician's decision made to correct drug therapy in accordance with the treat-to-target principle. Nonsteroidal antiinflammatory drugs (NSAIDs) are in most common use for the symptomatic therapy of RA. In spite of a significant reduction in pain and stiffness during therapy with NSAIDs, they do not affect the progression of X-ray changes. Virtually all NSAIDs may relieve pain when used in doses substantially smaller than those required to suppress inflammation. NSAIDs are an essential component of combination therapy for RA. They are given just at the early stage of the disease, by taking into account the gastrointestinal tract, kidney, and cardiovascular system. The National Institute for Health and Clinical Excellence in the United Kingdom proposes to administer analgesics (paracetamol and codeine) to reduce needs for NSAIDs in RA. For the time being, the use of analgesics in RA has, however, a weak evidence base. Different trials have also studied the efficiency of monotherapy with weak opioids, but it has proven to be also low. It is well, where possible, to avoid the long-term use of opioids. Along with NSAIDs and paracetamol, the recent guidelines of the International Expert Group of Pain Pharmacotherapy to use tricyclic antidepressants as additional agents to treat joint inflammatory diseases, which may be effective in some cohort of patients, such as those with RA and comorbid depressive disorders. Besides drug therapy, nonpharmacological methods are also successfully used in the treatment of pain in RA. The effective suppression of pain makes it possible not only to considerably reduce existing discomfort in a patient, but also to more correctly choose treatment policy in each specific case.

Learning curve in mucosal healing (MH) and inflammatory activity assessment by using the Erlangen MH score for confocal laser endomicroscopy (eMHs) in inflammatory bowel diseases

Introduction: Confocal laser endomicroscopy (CLE) is a modern imaging technique that enables real time histology, during endoscopy. Monitoring histological activity is important in evaluating the therapy response in IBD. Our group has recently validated an endomicroscopic mucosal healing score (eMHs), which has to be interpreted by skilled endoscopists.

AB0972 The Inconsistency between Clinical and Ultrasonographic Remission in Rheumatoid Arthritis

BackgroundThe approach to treating rheumatoid arthritis (RA) has changed over the last decade (1). Patients with disease in remission might show residual subclinical inflammation (2).ObjectivesThe aim of this study was...

Su1512 Learning Curve in Mucosal Healing (MH) and Inflammatory Activity Assessment by Using the Newly Validated Erlangen IBD-Mh Score for Confocal LASER Endomicroscopy

Confocal laser endomicroscopy (CLE) is a modern imaging technique that enables real time histology in vivo, during endoscopy, providing new insights of mucosal pathology. Monitoring histological activity to assess MH is important in evaluating the therapy response and management of inflammatory bowel diseases (IBD). Our group has recently validated an endomicroscopic mucosal healing score (eIBD-MHs), which has to be interpreted by skilled endoscopists.

Use of confocal laser endomicroscopy to predict relapse of ulcerative colitis

BackgroundAssessment of inflammatory activity in patients with ulcerative colitis (UC) is crucial to the prediction of relapse. Confocal laser endomicroscopy (CLE) is an accurate tool for assessing inflammatory activity in UC patients. This study aimed to evaluate whether CLE could be used to predict UC relapse reliably.MethodsIn total, forty-three patients with documented UC were analyzed in this study. Patients identified as having obvious active inflammation by conventional colonoscopy were excluded. The mucosa of each patient’s sigmoid colon and rectum was assessed by CLE before targeted biopsies were taken. The patients were then followed up for at least 12 months to evaluate relapse according to the Simple Clinical Colitis Activity Index. The correlation between CLE classification and UC relapse was evaluated.ResultsSeventeen of 20 patients with histologically confirmed normal or chronic inflammation were diagnosed as having non-active inflammation by real-time CLE and 22 of 23 patients with histologically confirmed acute inflammation were diagnosed as having active inflammation by CLE. The sensitivity, specificity, and accuracy of CLE in real-time diagnosis of active inflammation were 95.7%, 85%, and 90.7%, respectively. The agreement between CLE and conventional histology was excellent (kappa value = 0.812). Two of 18 (11.1%) patients who were classified as having non-active inflammation by CLE relapsed, while 16 of 25 (64%) patients classified as having as active inflammation relapsed. The relapse rate of patients with active inflammation was significantly higher than of those with non-active inflammation (P < 0.001).ConclusionsCLE is comparable to conventional histology in predicting relapse in patients with UC.

The role of the PET scan in the management of sarcoidosis

It is important to gain knowledge and understanding about the appropriate use of PET scan in the management of sarcoidosis patients. This means that, in view of the radiation dose and costs, defining appropriate indications for PET scanning in sarcoidosis patients is vital. PET has been shown to be a very sensitive technique for the assessment of inflammatory activity in sarcoidosis by detecting and quantifying the degree of inflammatory and granulomatous reactions that occur in the lungs and elsewhere in the body. PET is not indicated in the standard workup, but can be of great value to complement more routinely used techniques. On the basis of the current findings, PET offers added value in sarcoidosis patients with unexplained persistent disabling symptoms. PET appears especially helpful in those persistently symptomatic patients without serological signs of inflammatory activity, in patients with radiologic signs of fibrosis and in the detection of active cardiac sarcoidosis. The use of PET to assess the extent of disease can uncover a suitable location for biopsy to obtain histological evidence for the diagnosis or to explain the (mainly extrathoracic) symptoms. Furthermore, the detection of unexpected organ involvement may offer prognostic value.