Hand Joints Research Articles

Artificial intelligence model for segmentation and severity scoring of osteophytes in hand osteoarthritis on ultrasound images.

To develop an artificial intelligence (AI) model able to perform both segmentation of hand joint ultrasound images for osteophytes, bone, and synovium and perform osteophyte severity scoring following the EULAR-OMERACT grading system (EOGS) for hand osteoarthritis (OA). One hundred sixty patients with pain or reduced function of the hands were included. Ultrasound images of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), distal interphalangeal (DIP), and first carpometacarpal (CMC1) joints were then manually segmented for bone, synovium and osteophytes and scored from 0 to 3 according to the EOGS for OA. Data was divided into a training, validation, and test set. The AI model was trained on the training data to perform bone, synovium, and osteophyte identification on the images. Based on the manually performed image segmentation, an AI was trained to classify the severity of osteophytes according to EOGS from 0 to 3. Percent Exact Agreement (PEA) and Percent Close Agreement (PCA) were assessed on individual joints and overall. PCA allows a difference of one EOGS grade between doctor assessment and AI. A total of 4615 ultrasound images were used for AI development and testing. The developed AI model scored on the test set for the MCP joints a PEA of 76% and PCA of 97%; for PIP, a PEA of 70% and PCA of 97%; for DIP, a PEA of 59% and PCA of 94%, and CMC a PEA of 50% and PCA of 82%. Combining all joints, we found a PEA between AI and doctor assessments of 68% and a PCA of 95%. The developed AI model can perform joint ultrasound image segmentation and severity scoring of osteophytes, according to the EOGS. As proof of concept, this first version of the AI model is successful, as the agreement performance is slightly higher than previously found agreements between experts when assessing osteophytes on hand OA ultrasound images. The segmentation of the image makes the AI explainable to the doctor, who can immediately see why the AI applies a given score. Future validation in hand OA cohorts is necessary though.

Leukopenia that successfully treated by Ustekinumab in patient with psoriatic arthritis

Introduction:Psoriatic Arthritis (PsA) is an immune-mediated disease. The effectiveness of biologics has changed therapeutic strategies for psoriasis. We report a case of leukopenia in a patient with psoriatic arthritis (PsA) who was treated with Ustekinumab. Case presentation: A 36- year- old Syrian female presented for a follow up concerning treatment of psoriatic arthritis. She was diagnosed with psoriatic arthritis according to the CASPAR criteria. She was treated with Methotrexate, then Sulfasalazine. On presentation, the physical examination revealed tender in metacarpals, proximal interphalengal joints and distal interphalengal joints of both hands. Laboratory analysis showed: white blood cells (WBC) :3500 /mm3, (Neut:23% n = 40-65%, Lymp:65% n= 25-40%), erythrocyte sedimentation rate (ESR): 40 mm/h1, and C-reactive protein (CRP): 9.3 mg/L . Given the patient’s ongoing disease activity, and the presence of leukopenia, we started with Ustekinumab 45 mg subcutaneous. After the third dose of Ustekinumab, evaluation showed improvement in her peripheral arthritis and normal laboratory findings. Discussion: Patients with psoriasis had higher total white blood cell and neutrophil. Ustekinumab has good efficacy against disease activity as well as a favourable safety profile. In literature, we found a case of myelodysplastic syndrome associated with inflammatory bowel disease treated with Ustekinumab. Another case of constitutional neutropenia and psoriasis vulgaris treated with Ustekinumab. Conclusion: This is the first case of leukopenia associated with PsA successfully treated with Ustekinumab. UST treatment might be recommended for leukopenia associated with PsA, but further researches are recommended.

Outcome of Transfer Flexor Carpi Ulnaris And Plmaris Longus Tendons for Hand Deformity in Persistance Radial Nerve Palsy

Objective; the aim of our study is to evaluate the functional outcome of transfer flexor carpi ulnaris and palmaris longus for patients with persistence radial nerve palsy by minimal tendon transfer technique.
 Methods; The study included 10 patients 8 male and two female, mean age 25 years, range from 20 to 30 years. They underwent transfer of flexor carpi ulnaris (FCU) and palmaris longus (PL) tendon for patient with persistence radial nerve palsy, the duration of outcome of tendon transfer after radial nerve injury evaluated after one year. Clinical evaluation include wrist joint range of movement by Geniometry and compared with the contralateral normal side.
 Results; The average ranges of wrist movements were as the follows: the mean wrist flexion was 52⁰(range 46⁰–56⁰), the mean wrist extension was 34⁰(range 30–38), radial deviation 18⁰(range 16⁰–20⁰) and ulnar deviation 21⁰ (range 18–23). The mean extension of the fingers in wrist extension was 7⁰(range 5⁰–10⁰) and in wrist neutral position was 12⁰(range 9⁰–16⁰). The mean abduction of the thumb was 38⁰(range 35⁰–44⁰). In comparison to the measure of joints in the contralateral normal hand, the final extension of the wrist was less, but extension of the fingers and MCP joints was similar to that of the normal hand. All of the patients in our study were able to extend their fingers with the wrist in the neutral position. Thumb abduction and extension was sufficient to deal with daily activities and, even, heavy jobs in most of the patients. Postoperative follow up of the patients was ranged (12–24) months. After 45 days, 8o% of the patients were able to do the normal non heavy daily work. In 20% of cases recovery was not progressing satisfactorily at 5 weeks. These were referred to physiotherapy for a planned exercise program, which the two patients improved their movements.
 Conclusion; The purpose of this study was to evaluate function of the hand after transfer of the FCU to EDC and PL to EPL, with persistence high nerve injuries. The FCU & PL tendons transfer has some advantages over the other techniques, short duration of operation time, no morbidity, improve range of motion of hand and less surgical scares. It is a viable option to restore hand function and strength following radial nerve injuries.

Essential Fatty Acids and Osteoarthritis.

Inflammation worsens joint destruction in osteoarthritis (OA) and aggravates pain. Although n-3 fatty acids reduce inflammation, different n-3 fatty acids have different effects on inflammation and clinical outcomes, with eicosapentaenoic acid (EPA) having the strongest effect. We examined whether specific essential fatty acid levels affected the development of OA. We studied participants from the Multicenter Osteoarthritis Study (MOST) at risk of developing knee OA. As part of MOST, participants were asked repeatedly about knee pain, and knee radiographs and magnetic resonance images (MRIs) were obtained. Using baseline fasting samples, we analyzed serum fatty acids with standard assays. After excluding participants with baseline OA, we defined two sets of cases based on their status through 60 months' follow-up: those developing incident radiographic OA and those developing incident symptomatic OA (knee pain and radiographic OA). Controls did not develop these outcomes. Additionally, we examined worsening of MRI cartilage damage and synovitis and worsening knee pain and evaluated the number of hand joints affected by nodules. In regression models, we tested the association of each OA outcome with levels of specific n-3 and n-6 fatty acids, adjusting for age, sex, body mass index, education, physical activity, race, baseline pain, smoking, statin use, and depressive symptoms. We studied 363 cases with incident symptomatic knee OA and 295 with incident radiographic knee OA. The mean age was 62 years (59% women). We found no associations of specific n-3 fatty acid levels, including EPA, or of n-6 fatty acid levels with incident OA (eg, for incident symptomatic knee OA, the odds ratio per SD increase in EPA was 1.0 [95% confidence interval 0.87-1.17]). Results for other OA outcomes also failed to suggest a protective effect of specific n-3 fatty acids with OA outcomes. We found no association of serum levels of EPA or of other specific n-3 fatty acids or n-6 fatty acids with risk of incident knee OA or other OA outcomes.

Kinematic-driven human-robot interaction system with deep learning for flexible acupuncture needling manipulations

Acupuncture is an important therapeutic method in traditional Chinese medicine and essentially characterized by flexible needling manipulations that are complicated for repetitions. In this work, we designed a bio-inspired acupuncture robot combined with human–machine interaction system that can implement flexible and precise needle manipulations as manual acupuncture. In the proposed framework, the manual needling process was recorded with online imaging techniques. With a deep learning-based acupuncture estimator, kinetic parameters of lift insertion (LI) and twist rotation (TR) manipulations were extracted in three-dimensional space and the precent of correct key points for operator’s hand pose estimation achieved 94.03%. It is founded that the variation of operator’s finger vector angle for LI manipulation was much weaker than TR manipulation. Furthermore, inspired by kinematic characteristics of manual acupuncture, a six-degree-of-freedom robot was used to simulate the coordinated motion of hand joints in needling manipulations through robot kinematics analysis and trajectory planning with polynomial interpolation method. Numerical and experiential results showed that the acupuncture robot can mimic various needling manipulations as manual acupuncture. The flexibility and stability of the robotic acupuncture framework were evaluated for a wide range of needling parameters. It was demonstrated that the robot can follow the periodic dynamics of LI and TR manipulations with various frequencies and amplitudes, and perform accurate acupuncture operations with smooth needling trajectories as joint jitters during needle manipulations were completely eliminated. The presented results provide a new strategy for modern applications of acupuncture treatment with robotic and flexible needling manipulations to improve the therapeutic efficacy.

Causality between Ankylosing Spondylitis and osteoarthritis in European ancestry: a bidirectional Mendelian randomization study.

To explore the bidirectional causal relationship between Ankylosing Spondylitis (AS) and Osteoarthritis (OA) at the genetic level within the European ancestry. We implemented a series of quality control steps to select instrumental variables (IVs) related to the exposure. We conducted two-sample Mendelian randomization (MR) using the inverse-variance weighted method as the primary approach. We adjusted significance levels using Bonferroni correction, assessed heterogeneity using Cochrane's Q test. Sensitivity analysis was conducted through leave-one-out method. Additionally, external datasets and relaxed IV selection criteria were employed, and multivariate MR analyses were performed for validation purposes. Finally, Bayesian colocalization (COLOC) analysis identified common genes, validating the MR results. The investigation focused on the correlation between OA and AS in knee, hip, and hand joints. MR results revealed that individuals with AS exhibit a decreased risk of knee OA (OR = 0.9882, 95% CI: 0.9804-0.9962) but no significant increase in the risk of hip OA (OR = 0.9901, 95% CI: 0.9786-1.0018). Conversely, AS emerged as a risk factor for hand OA (OR = 1.0026, 95% CI: 1.0015-1.0036). In reverse-direction MR analysis, OA did not significantly influence the occurrence of AS. Importantly, minimal heterogeneity was observed in our MR analysis results (p > 0.05), and the robustness of these findings was confirmed through sensitivity analysis and multivariate MR analysis. COLOC analysis identified four colocalized variants for AS and hand OA (rs74707996, rs75240935, rs181468789, and rs748670681). In European population, individuals with AS have a relatively lower risk of knee OA, whereas AS serves as a risk factor for hand OA. However, no significant causal relationship was found between AS and hip OA. Additionally, it offers novel insights into genetic research on AS and OA.

A marker-based approach to determine the centers of rotation of finger joints

Background and ObjectiveThe methods proposed in literature to estimate the position of hand joints Centers of Rotation (CoRs) typically require computationally non-trivial optimization routines and exploit a high number of markers to calculate CoRs positions from surface marker trajectories. Moreover, most of the existing works evaluated the accuracy only in simulation. This work proposes a new procedure, based on the Pratt circle fit, to estimate joints CoRs position in 2D through marker-based acquisitions. MethodsThe advantage of the Pratt circle fit lies in its simplicity and computational speed, and in the possibility of exploiting a reduced markerset for calculating CoRs. By applying simplifying assumptions regarding the movement of the fingers (i.e., planar and decoupled flexion-extension movements of each joint occurring in the same flexion plane for all the joints of the finger), it is possible to determine the position of the CoR of each joint in 2D. For this reason, the estimation of the Carpo-MetaCarpal joint of the thumb was not included in this work, as it exhibits a more complex movement associated to the combination of a flexion-extension and adduction-abduction degree of freedom. The errors in estimating CoRs were evaluated by conducting experimental acquisitions on an anthropomorphic robotic hand and comparing the position of the estimated CoR with the real position of the CoR. The repeatability of the method and its capability to estimate anatomically plausible CoRs were evaluated through experimental acquisitions conducted on five healthy volunteers. ResultsErrors in estimating finger joints CoRs were in the order of 0.70 mm and 0.18 mm respectively along the finger longitudinal direction (i.e., x coordinate) and thickness (i.e., y coordinate). Standard Deviations of CoRs positions were comparable to the ones obtained in literature (i.e., below 2 mm and 1 mm respectively for the x and y coordinates), thus demonstrating the repeatability of the method. The Anatomical Plausibility Rate of the proposed approach was between 80% and 100%. ConclusionsThe performance of the Pratt-based CoRs estimation procedure proposed in this work was comparable to other existing methods, with the advantage of exploiting a simple fitting algorithm and a reduced markerset with respect to the state-of-the-art techniques.

Clinical features of patients with hands arthralgia referred from primary care physicians to rheumatologists: A cohort study

PurposeEarly referral of patients with suspicious of rheumatoid arthritis (RA) has an impact on prognosis. Our study aimed to evaluate the clinical characteristics of patients with hands arthralgia who were referred from primary care physicians (PCP) to the rheumatologist. MethodsA descriptive, observational, prospective cohort study was performed. We included patients who visited a PCP for the first time for hands arthralgia. Demographics and the European Alliance of Associations for Rheumatology criteria for arthralgia suspicious for progression to RA plus seven complementary questions, the time to referral, the pressure needed to provoke pain with an automatic squeeze test machine in the metacarpophalangeal joints of both hands, and the diagnoses established at the last review of medical charts from patients on follow-up were documented. The primary outcome was the referral to a rheumatologist. ResultsA total of 109 patients were included. The mean age was 49.9 years, 81.6% were women. 30.3% were referred to the rheumatologist. The time to referral was a median of 38 days. The main clinical characteristics associated with referral to the rheumatologist were the “most severe symptoms are present after midnight” (OR=6.29) and the “difficulty with making a fist” (OR=3.67). An isolated “positive squeeze test of metacarpophalangeal joints” was not associated with a referral to the rheumatologist. ConclusionsAmong patients with hands arthralgia who attended PCP, those with most severe symptoms after midnight and difficulty making a fist were more likely to be referred to the rheumatology clinic. Isolated positive squeeze tests are not a parameter for referral, it should only be performed if arthralgia is clinically suspected.

Osteoarthritis Increases the Frequency and Duration of Postoperative Hand Clinic Visits after Carpal Tunnel Release.

Carpal tunnel syndrome affects up to 6% of the general population, and surgical intervention is often required to ameliorate symptoms. Osteoarthritis (OA) is a common condition that often coexists with carpal tunnel syndrome. We hypothesized that patients with preexisting OA use more healthcare resources after carpal tunnel release (CTR) than patients without arthritis. This was a retrospective cohort study at a single academic center between January 1, 2018 and November 1, 2021. Patients who underwent CTR were included. Preoperative carpal tunnel symptoms, diagnostic tests, medications, and concomitant OA were abstracted. Hand, wrist, and basal joint arthritis were specified. The primary outcome was healthcare utilization represented by duration and frequency of hand clinic and occupational therapy (OT) follow-up. In total, 312 hands were included. Multivariable analysis was performed. The average duration of hand clinic follow-up among patients without arthritis was 25.3 days compared with 87.1 days for patients with any arthritis (P = 0.0375) and 172 days for patients with wrist arthritis (P = 0.012). The average number of postoperative surgeon visits was increased in patients with hand arthritis, with an average of 2.3 visits versus 1.34 visits for patients without arthritis (P = 0.003). Both the number of OT visits and the duration of OT follow-up did not differ between cohorts. After CTR, patients with preexisting OA use more healthcare resources than patients without OA.

Russel's sign: Unilateral hand callosities in bulimia nervosa.

A dermatology consult was sought for a 34-year-old female who presented with repeated vomiting and loss of weight, quantified to be around 13 kgs over the preceding 4 months. Examination revealed strictly unilateral callosities and few superficial erosions over the right distal hand, third and fourth metacarpophalangeal joints, and interphalangeal joints of the second digit, consistent with Russell's sign in bulimia nervosa. History of binge eating followed by purging by forced vomiting was found on dietary history.

Comparison of Joint Mobilization and Energy Conservation Technique in Rheumatoid Arthritis Patients in Hand Joints

Background: Rheumatoid arthritis is an auto-immune inflammatory condition that affects the hand, wrist,andknee joints.Joint mobilization is frequently used in RA patients. This study was to find the effectiveness of Jointmobilization and Energy conservation technique using range of motion measurement and Sollerman handfunction test in hand joints.Purpose: This study is to find the effect of Joint mobilization and Energy conservation technique which is a noninvasiveprocedure on Rheumatoid arthritis patients.Materials and Methods: A group of 60 Rheumatoid arthritis patients were selected according to inclusion andexclusion criteria from Saveetha medical college and hospital and SAGA Rehabilitation centre.they were dividedinto Joint mobilization group: (n=30) the subjects were treated with Joint mobilization and taught exercises to gainstrength and mobility for 3 days a week for 4 weeks for 15-30 minutes and Energy conservation group: (n=30) thesubjects are taught pacing the activities, prescribing assistive devices, foam-covered handles, wide grip handlesusing large joints to lift objects, teaching Proper body mechanics and Ergonomic considerations to be followed for4 weeks.Study period: November 2022 to April 2023.Result: A statistically significant difference between Joint Mobilization and Energy conservation technique groupsreveals that Joint mobilization has significant effects in lowering stiffness and pain and improving ROM of handjoints.Conclusion: Joint mobilization worked more effectively than energy conservation techniques in RA patients.

Ensemble Learning Method for the Continuous Decoding of Hand Joint Angles.

Human-machine interface technology is fundamentally constrained by the dexterity of motion decoding. Simultaneous and proportional control can greatly improve the flexibility and dexterity of smart prostheses. In this research, a new model using ensemble learning to solve the angle decoding problem is proposed. Ultimately, seven models for angle decoding from surface electromyography (sEMG) signals are designed. The kinematics of five angles of the metacarpophalangeal (MCP) joints are estimated using the sEMG recorded during functional tasks. The estimation performance was evaluated through the Pearson correlation coefficient (CC). In this research, the comprehensive model, which combines CatBoost and LightGBM, is the best model for this task, whose average CC value and RMSE are 0.897 and 7.09. The mean of the CC and the mean of the RMSE for all the test scenarios of the subjects' dataset outperform the results of the Gaussian process model, with significant differences. Moreover, the research proposed a whole pipeline that uses ensemble learning to build a high-performance angle decoding system for the hand motion recognition task. Researchers or engineers in this field can quickly find the most suitable ensemble learning model for angle decoding through this process, with fewer parameters and fewer training data requirements than traditional deep learning models. In conclusion, the proposed ensemble learning approach has the potential for simultaneous and proportional control (SPC) of future hand prostheses.

Bilateral hand dactylitis: An unusual presentation of the great imitator: Tuberculosis.

The incidence of tuberculosis in developed countries has decreased over the years due to the use of effective tuberculosis drugs and improvements in socio-economic conditions. However, with the ease of global transport and increased travel to countries with high tuberculosis prevalence, the reduction in extrapulmonary tuberculosis cases has been less significant compared with the overall decrease in tuberculosis cases. Extrapulmonary tuberculosis can manifest in a variety of ways. Tuberculous dactylitis, a rare form of tuberculous osteomyelitis, was first described by Rankin in 1886. It mainly affects the short tubular bones in the hands and feet of children and is sometimes called 'spina ventosa'. A 42-year-old male patient initially presented to an external centre reporting swelling and pain in the hand joints of one year's duration. Despite one year of treatment with leflunomide and methylprednisolone (16 mg) and a history of methotrexate use during this period, he experienced no improvement. The patient's condition worsened after the start of sulfasalazine. Dermatological examination was performed due to the presence of haemorrhagic crusted papules and plaques on the ventral surface of both hands. A wound culture was taken, but no bacterial growth was observed. One week after the initial evaluation, the patient complained of persistent foul-smelling nasal discharge, which led to an evaluation by the infectious disease department. At this time, the Quantiferon test was positive. Mycobacterial culture on Days 1 and 3 showed growth of the Mycobacterium tuberculosis complex.

Validity and reliability of the Duruöz Hand Index in patients with psoriatic arthritis.

The Duruöz Hand Index (DHI) is a valuable scale developed for evaluating hand functions of patients with rheumatoid arthritis and subsequently proven to be valid and reliable in various diseases. This study aims to investigate the validity and reliability of the DHI in patients with psoriatic arthritis (PsA). Patients diagnosed with PsA according to CASPAR criteria were enrolled. The demographic, clinical, and functional characteristics of patients were evaluated. Functional assessment was performed with DHI, Hand Functional Index, Health Assessment Questionnaire, and VAS-disability scale. C-reactive protein level, patients' and physicians' global VAS, swelling and tenderness of the hand joints, gross grip strength and thumb strength, and disease activity assessments were recorded as non-functional parameters related to active disease status. Reliability was assessed by internal consistency (with Cronbach's-a) and test-retest intraclass correlation coefficient. Face, content, convergent, and divergent validities were applied. One hundred and forty-four patients (74.3% female) were included in this study. The Cronbach's alpha coefficient was 0.963, and for the test-retest reliability of the DHI, the intraclass correlation coefficient was 0.904 (p < 0.001). DHI showed good correlations with the functional disability scales (Hand Functional Index, Health Assessment Questionnaire, VAS-disability), indicating its convergent validity and moderate to non-significant correlations with the non-functional parameters supporting its divergent validity. Despite the occurrence of significant deformities and functional loss in PsA patients, there is a noticeable absence of specific tools tailored for PsA. Considering the intricacies associated with skin, nail, tendon, entheseal involvement, and arthritis, there is a need for straightforward tools in both clinical practice and studies involving patients with PsA. The DHI is a valid and reliable scale to evaluate the functional disability of hands in patients with PsA.

Unified Cross-Structural Motion Retargeting for Humanoid Characters.

Motion retargeting for animation characters has potential applications in fields such as animation production and virtual reality. However, current methods either assume that the source and target characters have the same skeletal structure, or require designing and training specific model architectures for each structure. In this paper, we aim to address the challenge of motion retargeting across previously unseen skeletal structures with a unified dynamic graph network. The proposed approach utilizes a dynamic graph transformation module to dynamically transfer latent motion features to different structures. We also take into consideration for intricate hand movements and model both torso and hand joints as graphs in a unified manner for whole-body motion retargeting. Our model allows the use of motion data from different structures to train a unified model and learns cross-structural motion retargeting in an unsupervised manner with unpaired data. Experimental results demonstrate the superiority of the proposed method in terms of data efficiency and performance on both seen and unseen structures.

A research based study of quantitative analysis and segmentation of thermal images for assessing rheumatoid arthritis in the hand joints

A research based study of quantitative analysis and segmentation of thermal images for assessing rheumatoid arthritis in the hand joints

Development of a deep learning model for automated detection of calcium pyrophosphate deposition in hand radiographs.

Calcium pyrophosphate deposition (CPPD) disease is a leading cause of arthritis, which can mimic or strongly interfere with other rheumatic diseases such as gout, osteoarthritis (OA) or rheumatoid arthritis (RA). In the recently established ACR/EULAR CPPD classification criteria, calcification and OA features of the wrist and hand joints are substantial features. To develop and test a deep-learning algorithm for automatically and reliably detecting CPPD features in hand radiographs, focusing on calcification of the triangular fibrocartilage complex (TFCC) and metacarpophalangeal (MCP)-2 and -3 joints, in separate or combined models. Two radiologists independently labeled a dataset of 926 hand radiographs, yielding 319 CPPD positive and 607 CPPD negative cases across the three sites of interest after adjudicating discrepant cases. CPPD presence was then predicted using a convolutional neural network. We tested seven CPPD models, each with a different combination of sites out of TFCC, MCP-2 and MCP-3. The model performance was assessed using the area under the receiver operating characteristic (AUROC) and area under the precision-recall (AUPR) curves, with heatmaps (Grad-CAM) aiding in case discrimination. All models trialed gave good class separation, with the combined TFCC, MCP-2 and MCP-3 model showing the most robust performance with a mean AUROC of 0.86, mean AUPR of 0.77, sensitivity of 0.77, specificity of 0.80, and precision of 0.67. The TFCC-alone model had a slightly lower mean AUROC of 0.85 with a mean AUPR of 0.73. The MCP-2-alone and MCP-3-alone models exhibited mean AUROCs of 0.78-0.87, but lower mean AUPRs of 0.29-0.47. Heatmap analysis revealed activation in the regions of interest for positive cases (true and false positives), but unexpected highlights were encountered possibly due to correlated features in different hand regions. A combined deep-learning model detecting CPPD at the TFCC and MCP-2/3 joints in hand radiographs provides the highest diagnostic performance. The algorithm could be used to screen larger OA or RA databases or electronic medical records for CPPD cases. Future work includes dataset expansion and validation with external datasets.

Functional assessment of patients with systemic scleroderma. Recommendations for physiotherapists

Aim: To analyze the functional performance of patients with generalized scleroderma treated at the Department of Dermatology of the PIM of the Ministry of Internal Affairs and to develop recommendations for physiotherapists. Systemic sclerosis (SSc) is a chronic connective tissue disease characterized by progressive fibrosis of the skin and internal organs, the presence of microcirculatory disorders and the presence of autoantibodies. Materials and Methods: The study group consisted of 55 patients aged 27 years to 80 (mean 56.4) with systemic scleroderma, who receive rheological treatment in the Department of Dermatology on a cyclical basis. In addition, pharmacotherapy was supported by individually tailored rehabilitation for 2 years. Before and after the completed therapy, the results of the study were analyzed and recommendations were created for physiotherapists. Forty-two participated in the study. Results: All patients had mobility restrictions in the proximal and distal interphalangeal joints of both hands and in both temporomandibular joints. Conclusions: The study confirmed the need for guidelines for physiotherapists.

A ROLE OF AYURVEDIC MANAGEMENT IN AAMVATA W.S.T TO RHEUMATOID ARTHRITIS A CASE STUDY

One of the most prevalent disorders, aamavat is caused due to impairement of agni (digestive fire) and vitiation of vata dosha in addition to two other doshas. Aamavata is the consequence of Aam combining with Vata dosha and occupying Shleshmsthan (Asthisandhi). The primary pathogenic elements that cause the Aamvata are Vata and Aama. It is Madhyam Rogamarg's vyadhi. The primary locations where cardinal symptoms like Sandhishool, Sandhisotha, and Sandhigraha appear are Asthi and Sandhi. In modern textbooks, it is associated with the disease "Rheumatoid Arthritis"¹ based on clinical sympto matology. Present case is a female patient aged 54 years female having history of pain and morning stiffness in multiple small joints for one year, swelling in both hand and knee joints for 4 months, and lowgrade fever. On taking complete history and clinical evaluation lead to the diagnosis of Aamvata.considering the symptoms of Aamvata patient is treated according to the line of treatment of Aamvata². i.e Swedan, deepan, virechan, snehpan etc. Along with oral drugs for 30 days. Before starting the treatment, the grading was done on the basis of subjective criteria and after treatment, the grade was reduced. There was no side effect observed during and after the treatment. Therapy gives significant relief in symptoms of Aamvata.

Infrared hand joint dataset: a custom rheumatic hand thermal image dataset creation and its medically approved validation for extending research in diagnosing arthritis

Infrared hand joint dataset: a custom rheumatic hand thermal image dataset creation and its medically approved validation for extending research in diagnosing arthritis