Evaluation Of Disease Activity Research Articles

Delta corticomedullary apparent diffusion coefficient on MRI as a biomarker for prognosis in IgA nephropathy

Objectives To explore the association of the cortico-medullary difference in apparent diffusion coefficient (ΔADC) with clinicopathological parameters of disease activity at the time of biopsy, and with the prognositic risk stratification in IgA nephropathy (IgAN) patients. Methods We included 112 patients with biopsy-proven IgAN who measured ΔADC. Patients underwent a kidney biopsy and diffusion-weighted magnetic resonance imaging within one week of the biopsy. Clinicopathological characteristics were compared according to different ΔADC levels. The effect of ΔADC on eGFR and kidney fibrosis was explored using multivariate regression and ROC analysis. An individual’s 5-year risk probability of progressing to ESKD or decreasing of eGFR > 50% was calculated by the guidelines-recommended international risk-prediction tool in IgAN. The effect of ΔADC on prognostic risk stratification was assessed. Net reclassification improvement (NRI) was used to evaluate the model performance. Results The average ΔADC was 168.89 ± 85.1 x10−6 mm2/s. ΔADC levels decreased significantly with increasing chronic kidney disease (CKD) stages (p = 0.0038). Spearman correlation analysis revealed that ΔADC was positively correlated with eGFR, hemoglobin, serum albumin, while negatively correlated with levels of serum creatine (Scr), blood urea nitrogen (BUN), T score of Oxford classification and Lee grades (p < 0.05). Moreover, we showed that ΔADC was independently associated with eGFR (β = 0.04, 95% CI = [0.003, 0.077], p = 0.033) demonstrated by a backward stepwise multivariate linear regression analysis. Besides, ΔADC, a combination of ΔADC and eGFR showed an AUC of 0.776 (60% sensitivity and 85.3% specificity) and an AUC of 0.875 (100% sensitivity and 69.6% specificity) respectively for evaluating kidney interstitial fibrosis (IF) severity. Furthermore, ΔADC showed an AUC of 0.792 (95% CI 0.677-0.906) for differentiating higher progression risk categories from lower categories (specificity = 91.6%, sensitivity = 58.8%). The low-ΔADC group (≤ median value 167.1 × 10−6 mm2/s) was associated with 7.509-fold higher likelihood of higher progression risk compared to the high-ΔADC group (>167.1 × 10−6 mm2/s) in a fully-adjusted model. And reclassification analyses confirmed that the final adjusted model improved NRI. Conclusions ΔADC was significantly associated with kidney function and enabled a reliable evaluation of kidney IF severity in IgAN patients. Low ΔADC can predict a high 5-year kidney progression risk in IgAN, independent of important clinical factors. Moreover, the predictive ability to identify patients at high risk of severe kidney fibrosis and adverse progression estimates with satisfactory accuracy, facilitating ΔADC a promising and noninvasive tool in complementarily evaluating disease activity and the prognostic risk stratification in patients with IgAN.

Neutrophils-to-lymphocyte and platelet-to-lymphocyte ratio and Systemic Lupus erythematosus activity: a cross-sectional study in Brazilian patients

Background: To identify disease activity in Systemic Lupus Erythematosus (SLE) is important to choose the correct treatment. Neutrophil /Lymphocyte (N/L) and Platelet/ Lymphocyte (P/L) ratio have been considered to reflect inflammatory status in several situations. In this study, we aimed to evaluate the association of N/L and P/L with SLE disease activity. Methods: This is a crosssectional study of 189 SLE patients for disease activity for SLEDAI-2K (SLE Disease activity index), ESR (erythrocyte sedimentation rate), CRP (C reactive protein) and hemogram with N/L and P/L ratio. Results: N/L ratio demonstrated correlation with SLEDAI (rho=0.24; p=0.0009) ESR (rho =0.17; p=0.02) and CRP (rho=0.23; p=0,004); P/L correlated with SLEDAI (rho=0.21; p=0.003), CRP (rho=0.26; p=0.001), ESR (rho=0.23; p=0.003) and levels of anti-dsDNA (rho=0.29; p=0.02) and had a negative correlation with hemoglobin (rho= -0.27; p=0.0001). A cut-off of 2.28 in N/L ratio had sensitivity of 68.6% and specificity of 68.2% for active disease; a cut-off of 124.1 in P/L ratio had sensitivity of 82.9 and specificity of 41.1% for active SLE. Conclusions: N/L and P/L ratio are useful in the evaluation of SLE disease activity.

Clinical characteristics and quality of life of patients with Behcet’s disease with arthritis in Japan

Arthritis is one of the most common symptoms of Behcet’s Disease (BD) observed in 57% of Japanese patients with BD. The relationship between arthritis and other clinical symptoms of BD and the impact of arthritis on the quality of life (QOL) of patients with BD are still unclear. Therefore, the current study aimed to clarify the differences in clinical symptoms depending on the presence or absence of arthritis and evaluate the impact of arthritis on QOL in these patients. Fifty-three Japanese patients diagnosed with BD and being treated for more than 6 months were included in this study. Patients were divided based on the presence of arthritis symptoms into an arthritis and a non-arthritis group. Clinical symptoms, disease activity, and QOL of both groups were compared using the Patient’s global assessment (PGA), Evaluator’s global assessment (EGA), and Behcet‘s disease current activity form (BDCAF) as indices of disease activity. To evaluate disease activity related to lesions other than arthritis, BDCAF excluding arthritis items was also calculated. The Behcet’s disease quality of life (BDQOL) scale was used to assess patients’ QOL. Oral ulcers and skin lesions were significantly more frequent in the arthritis group than in the non-arthritis group (p = 0.009 and 0.048, respectively). Among skin domains, papulopustular lesions tended to be more frequent in the arthritis group. EGA and BDCAF (both including and excluding arthritis-related items) scores were significantly higher in the arthritis group (p = 0.019, < 0.0001, and 0.0004 respectively). Although PGA and BDQOL tended to be higher in the arthritis group, the difference between the two groups was not statistically significant. The disease course in Japanese BD patients with arthritis was more frequently complicated by oral ulcers and skin lesions than in those without arthritis. In addition, BD patients with arthritis tended to have generally higher disease activity and low QOL than their non-arthritis counterparts. Further research is required to confirm these results.

Validation of intestinal ultrasound scores in assessing endoscopic activity of colonic and small intestinal Crohn's disease in a southwest Chinese cohort: a retrospective cross-sectional study.

Recently, intestinal ultrasound (IUS) scores such as International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and Simple Ultrasound Score for Crohn's Disease (SUS-CD) have been established to evaluate disease activity in Crohn's disease (CD), but these require further external validation. This study thus aimed to compare recent IUS scores in patients with colonic or small intestinal CD in order to objectively assess their value and appropriate application. This retrospective study consecutively enrolled data of patients with CD from October 2020 to November 2022. The endoscopic and ultrasound images were collected, and the affected segments were rescored according to endoscopic scores [Simple Endoscopic Score for Crohn's Disease (SES-CD), Rutgeerts score for patients who have undergone surgery, and the Lewis score for CD of the small intestine]; IUS scores were also collected, including the IBUS-SAS, Ultrasound Consolidated Score (UCS), SUS-CD, Simple Ultrasound Score (Simple US Score), and Bowel Ultrasound Score (BUSS). Subsequently, the correlation of IUS scores with endoscopic scores and the identification of disease activity was calculated. The Spearman rank correlation coefficient was used to calculate the correlation of parameters, and the Kruskal-Wallis test was used to compare different groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficiency of each score, and corresponding area under the curve (AUC), cutoff values, sensitivity, specificity, and 95% confidence intervals (CIs) were calculated. A total of 203 patients were included in this study. All scores correlated well with endoscopic scores and showed the ability to identify colonic CD activity with high sensitivity and specificity. Among all the scores, IBUS-SAS had the highest value overall and for colonic CD, with sensitivity of 92.7% and a specificity of 91.4% in identifying endoscopic activity and a sensitivity of 95.0% and a specificity of 88.2% in identifying severe endoscopic activity. In small intestinal CD, the UCS showed the highest correlation with endoscopic score, with a relative coefficient of 0.708. The corresponding cutoff values for identifying endoscopic activity and severe activity were also calculated. Consistent with endoscopy, IUS scores are accurate in retrospective activity evaluation of CD, and suitable scores can be chosen according to the given circumstances.

Quality of life among patients with systemic lupus erythematosus in Karbala Governorate

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with a variety of clinical symptoms that primarily affect women of childbearing age causing a significant patient burden. Objectives: To assess health-related quality of life (HRQOL) among patients with SLE and to evaluate its association with different sociodemographic and clinical characteristics of SLE patients. Patients and methods: Seventy five patients with SLE who attended the rheumatology outpatient clinics of Imam Al-Hassan Al-Mujtaba Teaching Hospital, were enrolled in a cross-sectional study. Lupus quality of life (LupusQoL) was used to assess disease-specific health related quality of life; and SLE disease activity index (SLEDAI) was applied to evaluate disease activity. Results: The mean age of the studied patients was 38.12±11.70 years and were 97.3% female. All LupusQoL domains were reduced. Intimate relationship accounted for the highest QoL score with a median of 50, and IQR of 25-100, whereas fatigue represented the lowest score with a median of 25, and IQR of 6.2-50. LupusQoL was positively correlated to address, education, disease duration, occupation, and impact on job especially in physical health domain with r equal (0.277, 0.342, 0.137, 0.240, 0.314respectively). LupusQol was negatively correlated with age (r= -0.461), and with disease activity (r= -0.292), with p- values of all were &gt;0.05. Renal and neuropsychiatric involvement of the disease did not statistically correlate with HRQOL. Conclusion: patients with SLE had low scores of all LupusQoL domains. There was significant positive correlation between LupusQoL domains and address, education, disease duration, occupation, and impact on job and significant negative correlation with age, and disease activity. Key words: SLE, health related quality of life, LupusQoL

Fibromyalgia, mood disorders and chronic damage are the main determinants of worse quality of life in systemic lupus erythematosus patients: Results from a cross-sectional analysis.

As suggested by the EULAR recommendations, a comprehensive management of Systemic Lupus Erythematosus (SLE) should include the evaluation of disease activity, chronic damage, and quality of life (QoL). QoL is significantly impaired in SLE patients, even in those achieving a state of remission, suggesting the possible contribution of other factors. Thus, in the present study we aimed at analyzing QoL in a large SLE cohort by using LupusQoL, and at identifying the main determinant of poorer QoL. We conducted a cross-sectional study by including consecutive SLE patients diagnosed according to the 2019 ACR/EULAR criteria. Clinical, laboratory and therapeutical data were collected. Disease activity was assessed by SLEDAI-2k, while chronic damage by the SLICC Damage Index (SDI). The diagnosis of fibromyalgia was made in accordance with the ACR criteria (2016). At the time of the enrollment, all patients completed the following questionnaires: LupusQoL to assess quality of life and hospital anxiety and depression scale (HADS) for anxiety and depression. Our analysis included 237 SLE patients [92.4% female, median age 46years (IQR 19.5), median disease duration 156.8months (IQR 180.6)]. At the time of enrollment, we found a mean SLEDAI-2k of 1.7 (DS 2.4); 104 patients (43.9%) had chronic damage, with a mean SDI value of 0.8 (DS 1.3). Patients diagnosed with fibromyalgia were 69 (29.1%); moreover, HADS questionnaire identified a condition of anxiety and depression in 112 (47.3%) and 94 (39.7%) patients, respectively. The most compromised domain in the LupusQoL resulted "fatigue", followed by "burden to others". Patients with SDI ≥ 1 showed lower quality of life than patients without chronic damage, as demonstrated by significantly lower values in all items of the LupusQoL (p < .01). Furthermore, significantly lower values in all the LupusQoL domains were observed in patients with fibromyalgia, anxiety and depression, in comparison to those patients without these manifestations (p < .0001). No association was demonstrated between QoL and disease activity. Finally, the linear regression analysis confirmed mood disorders, in particular depression, and fibromyalgia as the main determinants of worse quality of life in our cohort. The present study demonstrated the influence of different factors in the quality of life of SLE patients. In particular, the presence of mood disorders, fibromyalgia and chronic damage resulted the main determinants of poorer QoL. This evidence reinforces the need for a comprehensive patient care.

Simplified magnetic resonance index of activity score versus simple endoscopic score in Crohn's disease: prospective study

BackgroundTo evaluate the correlation between simplified MR index of activity (sMaRIA) score and simple endoscopic score (SES-CD) in Crohn's disease activity assessment. A prospective study was done on established Crohn's disease patients referred to our institution. Magnetic resonance enterography and colonoscopy were performed as an activity assessment protocol searching for activity signs through calculation of sMaRIA score and SES-CD score and correlation between them. One hundred patients were enrolled in the study in period from July 2021 to July 2022. Patients with isolated upper gastrointestinal Crohn's disease (n = 4) or performed surgery before completion of activity assessment protocol (n = 9) or dropout (n = 18) were excluded. Patients with any age group, with ileal or colonic or ileo-colonic Crohn's disease and completed the protocol were eligible for the study (n = 69).ResultsSixty-nine patients with 345 bowel segments (five segments for each patient: ileum, right colon, transverse colon, left colon/sigmoid and rectum) were completely evaluated: 33 males and 36 females with mean age 29.16 ± 11.37 years. sMaRIA and SES-CD scores were calculated for each patient (global), and each bowel segment showed 97.50% sensitivity and 79.31% specificity at the level of global scores as well as significant positive correlation between the two scores at patient level/overall segments (rs = 0.816, p < 0.001), at ileal segments (rs = 0.704, p < 0.001) and colonic segments (right colon rs = 0.661, p ≤ 0.001, transverse colon rs = 0.586, p ≤ 0.001, left colon rs = 0.731, p < 0.001 and rectum rs = 0.786, p < 0.001). There were good inter-rater agreement between the two radiologists for the three parameters (wall thickness > 3 mm, mural edema and fat stranding) and moderate for mucosal ulcer detection with k value 0.666, 0.712, 0.712 and 0.565, respectively.ConclusionssMaRIA score is considered to be a reliable tool for Crohn's disease activity evaluation as compared to SES-CD.

Lupus nephritis: redefining the treatment goals

The course of proliferative lupus nephritis (LN) is characterized by flares of activity alternating with periods of quiescence, against a background of chronic immune dysregulation. An accurate assessment of disease activity is of unassailable importance to tailor therapy. In the present communication, we discuss the available clinical, serological and histological tools to evaluate disease activity and how they may be applied to redefine the treatment goals in LN. Traditionally, treatment response is judged by the degree of proteinuria reduction and improvement of kidney function, but this fails to differentiate ongoing inflammatory disease from chronic damage. Despite intensive research, no novel biomarker has proved useful for clinical practice, and we continue to rely on anti-double-stranded DNA antibody levels (anti-dsDNA) to assess serological activity. Repeat kidney biopsies sometimes reveal persistent inflammation despite apparent clinical remission, giving credibility to the conviction that histological remission should be a treatment goal and protocol biopsies part of the decision-making process. However, the discrepancies between clinical and histological responses to therapy can be explained by persistent systemic autoimmunity with low-grade immune complex deposition or, alternatively, by delayed clearance of intrarenal inflammation once immunological remission has been achieved. Since persistent immune dysregulation is the motor of disease activity in LN, it should be the principal focus of therapy and monitoring. We propose to replace the traditional induction-remission maintenance protocol by a more dynamic and individualized approach, and aim for 3 treatment goals, concomitantly rather than sequentially: 1) Clinical remission, by attenuating renal inflammation, using microscopic hematuria, proteinuria, eGFR and complement levels as biomarkers; 2) Immunological remission, by decreasing immune complex generation, using anti-dsDNA as biomarker; 3) Preservation of kidney function, by curtailing chronic kidney damage, using eGFR slope as biomarker.

Scavenger receptor-A is a sensitive disease activity biomarker in ESR and CRP normal rheumatoid arthritis.

Identification of rheumatoid arthritis (RA) patients in active disease with normal ESR and CRP is a challenge in disease activity assessment. The objective of this study was to evaluate the performance and clinical significance of Scavenger receptor-A (SRA) as a disease activity biomarker in RA, especially in ESR and CRP normal patients. One hundred and sixty-two RA (40 discovery cohort; 122 validation cohort), 20 osteoarthritis (OA), and 36 healthy controls (HCs) were recruited. Ten disease activity markers were evaluated by Bio-Plex Pro Human Cytokine Assay in the discovery cohort. SRA levels were measured by enzyme-linked immunosorbent assay (ELISA) in the validation cohort. The association between SRA and clinical phenotypes was also analyzed. ROC analysis was performed for disease activity prediction. SRA was found to be correlated with disease activity in the discovery cohort. The serum SRA level was verified by ELISA in the validation cohort, and was found to be correlated with disease activity index in RA patients, including DAS28-ESR (r = .477, p < .001), swollen joint counts, and tender joint counts; as well as inflammation markers, including ESR and CRP. In ESR and CRP normal RA, there was a strong correlation between SRA and DAS28-ESR ( = 4.564, p = .003). In addition, area under the ROC of SRA was higher than AUCESR and AUCCRP in ESR and CRP normal RA patients, suggesting that serum SRA could be more sensitive than ESR and CRP for disease activity assessment in this group of patients. In the low DAS28-ESR (≤3.2) group, the AUC of SRA for disease activity measurement was higher than that of ESR and CRP, indicating that SRA was also more sensitive than ESR and CRP in low-disease activity RA. SRA was correlated with RA disease activity and may be a sensitive serum biomarker for disease activity evaluation, especially in ESR and CRP normal patients, as well as in the low-disease activity group. SRA could be a promising marker for disease activity assessment.

Comprehensive quantitative magnetic resonance imaging assessment of skeletal muscle pathophysiology in golden retriever muscular dystrophy: Insights from multicomponent water T2 and extracellular volume fraction.

Quantitative MRI and MRS have become important tools for the assessment and management of patients with neuromuscular disorders (NMDs). Despite significant progress, there is a need for new objective measures with improved specificity to the underlying pathophysiological alteration. This would enhance our ability to characterize disease evolution and improve therapeutic development. In this study, qMRI methods that are commonly used in clinical studies involving NMDs, like water T2 (T2H2O) and T1 and fat-fraction (FF) mapping, were employed to evaluate disease activity and progression in the skeletal muscle of golden retriever muscular dystrophy (GRMD) dogs. Additionally, extracellular volume (ECV) fraction and single-voxel bicomponent water T2 relaxometry were included as potential markers of specific histopathological changes within the tissue. Apart from FF, which was not significantly different between GRMD and control dogs and showed no trend with age, T2H2O, T1, ECV, and the relative fraction of the long-T2 component, A2, were significantly elevated in GRMD dogs across all age ranges. Moreover, longitudinal assessment starting at 2months of age revealed significant decreases in T2H2O, T1, ECV, A2, and the T2 of the shorter-T2 component, T21, in both control and GRMD dogs during their first year of life. Notably, insights from ECV and bicomponent water T2 indicate that (I) the elevated T2H2O and T1 values observed in dystrophic muscle are primarily driven by an expansion of the extracellular space, likely driven by the edematous component of inflammatory responses to tissue injury and (II) the significant decrease of T2H2O and T1 with age in control and GRMD dogs reflects primarily the progressive increase in fiber diameter and protein content during tissue development. Our study underscores the potential of multicomponent water T2 relaxometry and ECV to provide valuable insights into muscle pathology in NMDs.

Joint hypermobility in rheumatoid arthritis: A case- control study

Objective: To evaluate the presence of joint hypermobility (JH) in rheumatoid arthritis (RA) patients and the relationship between JH and disease activity, hand functions, and quality of life. Methods: Thirty-four seropositive RA patients and 34 controls were included. Demographic data, body mass index, and state of JH (Beighton scores) of all participants were recorded. Two groups were compared in terms of JH. In RA patients, the Disease Activity Score-28 (DAS-28) was used to evaluate disease activity, the Duruöz Hand Index (DHI) for hand functions, and the Nottingham Health Profile (NHP) for quality of life. A correlation analysis was performed to evaluate the relationship of these data with JH in RA patients. Results: In the RA group, there were no patients with JH. No significant difference was found in the Beighton scores compared to the control group (p=0.383). The Beighton score showed a statistically significant negative correlation with DAS-28, DHI, NHP total, NHP pain, NHP physical activity, and NHP energy level. (p=0.026, p=0.015, p=0.003, p

Factors affecting discrepancies in disease activity evaluation between patients and physicians in systemic lupus erythematosus-The importance of symptoms such as fatigue.

There are often discrepancies in the evaluation of disease activity between patients and physicians in systemic lupus erythematosus (SLE). In this study, we examined the factors that affect those evaluations. Physician visual analogue scale (Ph-VAS), patient VAS (Pt-VAS), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2k), glucocorticoid (GC) usage and dose, age, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and three patient-reported outcomes (SLE symptom checklist [SSC], short-form 36 questionnaire [SF-36], and LupusPRO) were obtained from a study performed in 2019 using 225 SLE outpatients of the Kyoto Lupus Cohort at Kyoto University Hospital. Correlations among Ph-VAS, Pt-VAS, or dif (Pt-VAS-Ph-VAS) (Pt-VAS minus Ph-VAS) and other factors were examined. We found a significant discrepancy between Pt-VAS (median 38.0mm) and Ph-VAS (median 18.7mm) scores (p < 0.001). SSC score showed a significant correlation with Pt-VAS and dif (Pt-VAS-Ph-VAS) (p < 0.001). Among SSC items, fatigue showed the most significant correlation with dif (Pt-VAS-Ph-VAS). We also showed that higher dif (Pt-VAS-Ph-VAS) was associated with lower quality of life (QOL) evaluated by SF-36 and LupusPRO. Pt-VAS scores tended to be higher than Ph-VAS scores, and the discrepancy was influenced mainly by fatigue. Higher dif (Pt-VAS-Ph-VAS) was associated with lower patient QOL.

Evaluation of disease activity in systemic lupus erythematosus using standard deviation of lymphocyte volume combined with red blood cell count and lymphocyte percentage

Systemic lupus erythematosus (SLE) commonly damages the blood system and often manifests as blood cell abnormalities. The performance of biomarkers for predicting SLE activity still requires further improvement. This study aimed to analyze blood cell parameters to identify key indicators for a SLE activity prediction model. Clinical data of 138 patients with SLE (high activity, n = 40; moderate activity, n = 44; mild activity, n = 37; low activity, n = 17) and 100 healthy controls (HCs) were retrospectively analyzed. Data from 89 paired admission–discharge patients with SLE were collected. Differences and associations between blood cell parameters and disease indicators, as well as the relationship between the these parameters and organ damage, were examined. Machine-learning methods were employed to develop a prediction model for disease activity evaluation. Most blood cell parameters (22/26, 84.62%) differed significantly between patients with SLE and HCs. Analysis of 89 paired patients with SLE revealed significant changes in most blood cell parameters at discharge. The standard deviation of lymphocyte volume (SD-V-LY), red blood cell (RBC) count, lymphocyte percentage (LY%), hemoglobin(HGB), hematocrit(HCT), and neutrophil percentage(NE%) correlated with disease activity. By employing machine learning, an optimal model was established to predict active SLE using SD-V-LY, RBC count, and LY% (area under the curve [AUC] = 0.908, sensitivity = 0.811). External validation indicated impressive performance (AUC = 0.940, sensitivity = 0.833). Correlation analysis revealed that SD-V-LY was positively correlated with ESR, IgG, IgA, and IgM but was negatively correlated with C3 and C4. The RBC count was linked to renal and hematopoietic system impairments, whereas LY% was associated with joint/muscle involvement. In conclusion, SD-V-LY is associated with SLE disease activity. SD-V-LY combined with RBC count and LY% contributes to a prediction model, which can be utilized as an effective tool for assessing SLE activity.

The Role of Faecal Calprotectin in the Evaluation of Disease Activity in Spondyloarthritis Patients: A Cross-sectional Study

The Role of Faecal Calprotectin in the Evaluation of Disease Activity in Spondyloarthritis Patients: A Cross-sectional Study

Evaluation of Inflammatory Disease Activity in the Sacroiliac Joints Using Magnetic Resonance Imaging: A Comparative Analysis of Short-Tau Inversion Recovery, Post-Contrast, and Diffusion-Weighted Imaging –Preliminary Study

Introduction: It is essential to detect sacroiliitis earlier to decrease morbidity and unwanted complications such as ankylosing of sacroiliac joints. In recent studies, magnetic resonance imaging (MRI) serves as a key diagnostic tool for identifying sacroiliitis and is now included in the diagnostic criteria. We aim to detect the utility of diffusion-weighted imaging on the MRI in diagnosing sacroiliitis and measure ADC values for the response to treatment in future studies. Materials -methods: There were 39 patients (16 male, 20 female). A 1.5 Tesla MR device with a pelvic coil was used. The sequences were T1 (before and after intravenous contrast administration of gadolinium), T2-weighted fast field echo, short tau inversion recovery (STIR), diffusion-weighted (DW) images, and apparent diffusion coefficient (ADC) mapping. Sacroiliac joints were divided into four quadrants, and two radiologists interpreted all the sequences by giving scores from 0 to 3 depending on bone marrow edema from none to severe. The concordance of scores assigned to STIR, T1-weighted gadolinium-enhanced images, ADC mapping, and diffusion-weighted MR images was evaluated by calculating intraclass correlation coefficients. Results: A statistically significant positive correlation was observed between the activity scores derived from short tau inversion recovery (STIR) and other magnetic resonance (MR) sequences, namely T1-weighted gadolinium-enhanced images, apparent diffusion coefficient (ADC) mapping, and diffusion-weighted MR images. Conclusion: Active bone marrow abnormalities were identified with comparable efficacy using STIR imaging and other MR sequences (T1W-Gad, ADC mapping, DW-MR). In our study, we tried to emphasize the role of the diffusion-weighted images near the other sequences. Diffusion is a fast, easy-applied sequence. After increased experience in the diffusion-weighted images, routine application of this sequence will increase, and even becoming one of the diagnostic criteria will be inevitable. The difference in DWI from the other sequences is that it is measurable. The response to treatment may be followed up by ADC values.

Fibroblast activation protein inhibitor positron emission tomography imaging in muscles of patients with idiopathic inflammatory myopathy.

Mesenchymal stromal cells in muscles participate in regeneration following muscle injury. This study explored the potential of [18F]fibroblast activation protein inhibitor (FAPI)-42 positron emission tomography (PET) targeting mesenchymal stromal cells to evaluate disease activity of idiopathic inflammatory myopathy (IIM). Patients with IIM (n = 26) were prospectively included and underwent [18F]FAPI-42 PET/CT and whole-body MRI between January 2023 and July 2023. Patients with malignancies were retrospectively included in the control group and only underwent [18F]FAPI-42 PET/CT (n = 28). [18F]FAPI-42 PET/CT images were evaluated using for avid-FAPI uptake and the target-to-background ratio (TBR). Whole-body MRI was evaluated for oedema, fatty infiltration, and atrophy in 42 muscles in the IIM group. The global FAPI- and MRI-derived parameters were calculated for each. . Clinical assessment of disease activity and muscle strength were collected. Patients with IIM had significantly higher global FAPI-avid muscle ratios (0.68 [interquartile range (IQR): 0.45, 0.79] vs 0.06 [IQR: 0, 0.11], p< 0.001) and global muscle TBR (2.26 [IQR: 1.71, 2.75] vs 1.23 [IQR: 1.02, 1.52], p< 0.001) compared with controls. In the IIM group, the median TBR was higher in muscles with oedema than in those without (2.44 [IQR: 1.46, 3.27] vs 1.31 [IQR: 0.95, 1.99], p< 0.001). Global FAPI-avid muscle ratios significantly correlated with global oedema score (r = 0.833), muscle strength (r=-0.649), serum creatine kinase (r = 0.456), and disease activity index (r = 0.495-0.621). Increased [18F]FAPI-42 uptake was associated with muscle oedema in IIM. FAPI-derived parameters correlated with IIM disease activity. [18F]FAPI-42 is a promising PET tracer for evaluating IIM disease activity.

CONTExT-RA: a cross-sectional study evaluating disease activity, quality of life and the socio-demographic profile of Irish patients with rheumatoid arthritis.

CONTExT-RA is a cross-sectional, non-interventional multicentre study which enrolled patients diagnosed with RA and receiving DMARD treatment in a secondary care setting. The study evaluated disease control and associated disease burden amongst this Irish population. Patients with RA attending six Irish rheumatology centres were invited to participate. Each consented patient attended a single routine study visit. Disease activity was assessed using Clinical Disease Activity Index (CDAI). The primary endpoint was EuroQol-5 dimensions (EQ-5D-5L) stratified by CDAI, compared using a non-parametric Wilcoxon Rank-Sum test. 130 patients were included. Using CDAI, 34 (26.2%) patients were in clinical remission (CR), 42 (32.3%) had low disease activity (LDA), 41 (31.5%) had moderate disease activity (MDA) and 13 (10.0%) had high disease activity (HDA). QoL (EQ-5D-5L index (median)) scores were significantly (P < 0.001) greater for patients in CR or CR/LDA than for those with MDA/HDA, 0.866 (0.920), 0.777 (0.822) vs 0.578 (0.691), respectively. Patients in CR reported higher levels of work productivity, mean (s.d.) rating of 1.7 (2.52) vs those in MDA/HDA of 4.2 (3.28) (higher rating indicates greater impairment). Similar findings were observed for non-work-related activities. Disease control for many patients with RA, treated in secondary care in Ireland, is sub-optimal with only 1 in 4 in CDAI remission. The impact of poor disease control on QoL is significant, and the superior outcomes for patients in CR provide compelling evidence that by achieving greater disease control, the burden of disease on patients can be greatly reduced.

Assessment of hepcidin in Egyptian patients with rheumatoid arthritis and its relation to anemia: a single-center study

BackgroundRheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder characterized by synovial inflammation that leads to joint damage, bony erosions, and related deformities. Between 30 and 70% of RA patients will experience anemia. Early detection of anemia is of great importance. This study aimed to evaluate the serum level of hepcidin (HEP) in RA patients and to assess its relation to disease activity and anemia. The current cross-sectional study included 44 cases with RA in addition to 44 healthy controls. The disease activity in the RA patient was assessed by using the disease activity score (DAS) 28 score-CRP. The serum levels of HEP and ferritin were assessed in both groups using enzyme-linked immunosorbent assay (ELISA) technique.ResultsHepcidin level in the RA group was statistically significantly higher as compared to the control group (p = 0.001). The prevalence of Anemia of chronic disease (ACD) was 40.9%, and iron deficiency anemia (IDA) was 27.3% which accounted for 68.2% of the total anemia cases. The HEP level was statistically significantly higher in the RA patients with ACD than those without anemia (P = 0.028), RA patients with IDA (P < 0.001), and control group (P < 0.001). There was a statistically significant positive correlation between HEP level and serum ferritin level (p = 0.005). HEP level was significantly and inversely correlated with hemoglobin (Hb) in patients with ACD. Serum HEP level is higher in RA patients with high disease activity than those with moderate activity, low activity, and patients in remission (p = 0.380). However, the difference was not statistically significant. The best cutoff point of HEP level to identify RA patients from healthy controls was > 355.5 Pg/ml. This point showed moderate sensitivity (70.5%) with moderate specificity (63.6%) with a statistically significant value.ConclusionsWe found the anemia, and particularly ACD, is more common in RA patients. In RA patients with ACD, serum HEP levels were considerably higher. Although serum HEP showed no diagnostic significance when it came to evaluating disease activity, it could be a dependable non-invasive biomarker for the diagnosis of various forms of anemia in RA patients.

Relationship between MRI findings and renal histopathology in IgG4-related tubulointerstitial nephritis.

MRI is expected to be a valuable tool for evaluating disease activity in immunoglobulin G4 (IgG4)-related tubulointerstitial nephritis (IgG4-TIN). However, the correlation between MRI findings and renal histopathological findings remains to be elucidated. This study aimed to clarify the correlation between MRI findings and renal histopathological findings in IgG4-TIN. This retrospective cross-sectional study investigated 26 patients with biopsy-proven IgG4-TIN who underwent simultaneous percutaneous kidney biopsies and abdominal MRI examinations at Toranomon Hospital or Toranomon Hospital Kajigaya between December 2007 and November 2022. We reviewed kidney biopsy specimens and scored the degree of inflammatory cell infiltration and interstitial fibrosis. We assessed abdominal MRI, specifically examining T1WI, T2WI, and DWI, for the presence of abnormal signals in the inferior pole of the kidney on the side where the kidney biopsy was performed. Spearman's correlation coefficient test was conducted to examine the relationship between the images and histological findings. For T1WI, eight cases showed a positive low-intensity signal, and 18 cases were negative. For T2WI, 19 cases were positive for a low-intensity signal, and seven cases were negative. In DWI, 23 cases were positive for a high-intensity signal, and one was negative. T1WI low-intensity signal and T2WI low-intensity signal were significantly correlated with interstitial fibrosis score (correlation coefficient 0.52 and 0.64). DWI revealed IgG4-TIN detected IgG4-TIN lesions with the highest sensitivity; however, the correlation with inflammatory cell infiltration score was not significant. Low-intensity signal on T2WI is useful for predicting the degree of fibrosis in IgG4-TIN.

Endpoints and outcomes for localized scleroderma/morphea: a scoping literature review

BackgroundCurrent treatment for localized scleroderma (LS) has been shown to halt disease activity, but little is still known about patient experiences with these treatments, nor is there consensus about optimal measurement strategies for future clinical trials.ObjectiveConduct a scoping review of the literature for the types of outcomes and measures (i.e. clinician-, patient-, and caregiver-reported) utilized in published treatment studies of LS.MethodsOnline databases were searched for articles related to the evaluation of treatment efficacy in LS with a special focus on pediatrics.ResultsOf the 168 studies, the most common outcomes used were cutaneous disease activity and damage measured via clinician-reported assessments. The most frequently cited measure was the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT). Few patient-reported outcome measures (PROMs) were used.LimitationsSome studies only vaguely reported the measures utilized, and the review yielded a low number of clinical trials.ConclusionIn addition to evaluating disease activity with clinician-reported measures, the field could obtain critical knowledge on the patient experience by including high-quality PROMs of symptoms and functioning. More clinical trials using a variety of outcomes and measures are necessary to determine the most suitable course of treatment for LS patients.