Joint Involvement Research Articles

Frequency of multisite non-hand joint involvement in patients with thumb-base osteoarthritis, and associations with functional and patient-reported outcomes

PurposeIn OA studies, the focus often is on an index-joint; other affected joint sites are often overlooked. In this thumb-base OA study, we documented the frequency of symptomatic non-hand joint sites and investigated whether their count was associated with thumb-specific functional and patient-reported outcome measures. DesignPatients seeking care for thumb-base OA (conservative or surgical) were included. A patient-completed questionnaire captured sociodemographic and health characteristics, symptomatic hand and non-hand joint sites, and outcome measures (thumb-base pain intensity, symptoms and disability (TASD) and upper-extremity disability/symptoms (quickDASH)). Grip and pinch strength were measured. Linear regressions examined the association between each outcome and symptomatic joint site count, adjusted for several covariates. ResultsThe mean age of the 145 patients was 62 years, 72% were female. Mean symptomatic non-hand joint site count was 3.6. Ten percent reported only their hands as symptomatic; 30% reported 2–3 other symptomatic sites, and 49% reported 4+. From cross-sectional multivariable analyses, a higher symptomatic non-hand joint site count was associated with worse scores for all patient-reported outcomes and grip strength. Every unit increase in joint site count (49% had a 4+ count) was associated with a 2.1–3.3 unit increase (worse) in patient-reported outcome scores (all p ​< ​0.02). ConclusionsIn this sample, nearly 80% of patients had 2+ symptomatic non-hand joint sites. These symptoms were associated with worse thumb- and hand-specific outcomes, suggesting a need for awareness of whole body OA burden, with implications for outcome score interpretations, study designs, and provision of care in thumb-base OA.

Refractory inflammatory arthritis definition and model generated through patient and multi-disciplinary professional modified Delphi process.

Various definitions have been proposed for Refractory Disease in people with Rheumatoid Arthritis; however, none were generated for Polyarticular Juvenile Idiopathic Arthritis or involving adult and paediatric multidisciplinary healthcare professionals and patients. The study aim is to redefine Refractory Disease, using Delphi methodology. Three rounds of surveys (one nominal group and two online (2019-2020)) to achieve consensus using a predetermined cut-off were conducted voting on: a) name, b) treatment and inflammation, c) symptoms and impact domains, and d) rating of individual components within domains. Theoretical application of the definition was conducted through a scoping exercise. Votes were collected across three rounds from Patients, Researchers and nine multi-disciplinary healthcare professional groups (n = 106). Refractory Inflammatory Arthritis was the most popular name. Regarding treatment and inflammation, these were voted to be kept broad rather than specifying numbers/cut-offs. From 10 domains identified to capture symptoms and disease impact, six domains reached consensus for inclusion: 1) Disease Activity, 2) Joint Involvement, 3) Pain, 4) Fatigue, 5) Functioning and Quality of Life, and 6) Disease-Modifying Anti-Rheumatic Drug Experiences. Within these domains, 18 components, from an initial pool (n = 73), were identified as related and important to capture multi-faceted presentation of Refractory Inflammatory Arthritis, specifically in Rheumatoid Arthritis and Polyarticular Juvenile Idiopathic Arthritis. Feasibility of the revised definition was established (2022-2023) with good utility as was applied to 82% of datasets (n = 61) incorporating 20 outcome measures, with two further measures added to increase its utility and coverage of Pain and Fatigue. Refractory Inflammatory Arthritis has been found to be broader than not achieving low disease activity, with wider biopsychosocial components and factors incorporating Persistent Inflammation or Symptoms identified as important. This definition needs further refinement to assess utility as a classification tool to identify patients with unmet needs.

A Brief Review of the International Experience of Commercialization of Scientific Research

Today, it is impossible to achieve sustainable development of the country's economy without scientific research. At the same time, it is necessary to disseminate research results and practical use through commercialization. It should be noted that the knowledge transfer, technologies and inventions from research to commercialization is a rather complex process and requires the joint involvement of both - science and business, as well as political decision-makers. In this paper, the difficulties and opportunities related to commercialization, as well as the role and purpose of universities in this process, are discussed on the example of different countries. There must be mentioned that along with the general defining framework conditions, personal factors such as risk attitude, motivation, self-satisfaction and others play a decisive role in connecting science and business. Scientific fields with special commercial potential in different countries are also discussed in the paper. On the example of some countries, political decisions that directly or indirectly influence the implementation and commercialization of academic research results in the real environment are also presented. Keywords: Commercialization, Scientific research, Technology transfer, Commercialization promoting policies, University research.

Musculoskeletal Involvement in Pediatric Behçet's Disease: A Single Center Experience

Background: Behçet’s disease (BD) is an inflammatory disease characterized by recurrent oral ulcers, genital ulcers, ocular manifestations, and vascular involvement. Musculoskeletal symptoms are common both at the time of presentation and throughout the course of BD, and similar symptoms are also observed in pediatric Behçet’s disease (PEDBD). This study aims to report the frequency and role of musculoskeletal involvement in PEDBD followed by our clinic. Method: This retrospective medical record review included a total of 90 patients diagnosed with PEDBD before the age of 16 years between January 2010 and December 2022. Results: Of the patients, 48 (53.3%) were female and 42 (46.7%) were male. Their mean age at diagnosis was 12.4 years. All patients (100%) had recurrent oral ulcers, while 55 (61.1%) had genital ulcers, 44 (48.9%) had musculoskeletal involvement, 37 (41.1%) had skin manifestations, 19 (21.1%) had ocular involvement, 17 (18.9%) had neurological involvement, and 17 (18.9%) had vascular involvement. Among the patients with joint involvement, 27 (65.9%) had arthritis, 41 (100%) had arthralgia, 37 (90.1%) had oligoarticular joint involvement, and 29 (70.7%) had unilateral involvement. The most commonly affected joints in the patients was in the knee (63.4%), followed by the ankle (31.7%), the wrist (19.5%), sacroiliac joints (14.6%), the hands (12.2%), the elbow (9.8%), and the feet (4.9%). Conclusions: Musculoskeletal symptoms are common in PEDBD and can be observed as an early sign of the disease at the time of diagnosis. Therefore, it is important to thoroughly inquire about possible BD in children with musculoskeletal symptoms.

Stairway to Heaven: Do head-to-head Trials Indicate a Need for Definite Criteria for Choosing Biologic Drugs in Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a chronic disease characterized by joint and systemic involvement that develops with different pathogenetic mechanisms. Treatment of the disease is undertaken with disease-modifying anti-rheumatic drugs (DMARDs). The mechanisms of action of conventional DMARDs generally are based on the inhibition of T and B-cells in the immune system. In recent years, biologic and targeted smart molecules have been used in the treatment of RA. Targeting different cytokines and inflammatory pathways, these drugs have ushered in a new era in RA treatment. The efficacy of these drugs has been demonstrated in many studies; and in the postmarketing period, that is, as the patients who use them say, they are like a "stairway to heaven". However, as every "road to heaven" is challenging and "thorny", the efficacy and reliability of these drugs and whether any one of them is superior to the others, remains a matter of debate. However, the use of biologic drugs with or without cDMARDs, the preference for original vs. biosimilar molecules, and discontinuation of the drugs after achieving sustained remission are other questions that need to be explored. When it comes to the choice of biological drugs by rheumatologists, it is not yet clear on which criteria they base their choices on. Due to the limited comparative studies of these biological drugs, the subjective criteria of the physician gains importance. The selection of these drugs, however, should be based on objective criteria such as efficacy, safety, superiority over each other, and cost. In other words, the determinant of the "path to heaven" should be based on objective criteria and recommendations according to the scientific data generated by controlledprospective studies, not on the initiative of a single physician. In this review, a head-to-head comparison of biological drugs used in the treatment of RA, their efficacy, safety, and which are superior are discussed in light of recent literature data.

Adipokine Profile on Joint and Periodontal Conditions in First-degree Relatives of Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by joint inflammation and destruction. Establish the association between Porphyromonas gingivalis (P. gingivalis) infection, body mass index (BMI), joint involvement, and serum adipokines in first-degree relatives (FDR) of patients with rheumatoid arthritis (RA). The cross-sectional study evaluated 124 FDR and 124 healthy controls (HC). The clinical examination included joint and radiographic evaluation and calculation of BMI. Serum adipokine levels were measured (leptin, vaspin, adiponectin, resistin, and adipsin), as were the erythrocyte sedimentation rate, C-reactive protein, and anti-citrullinated protein antibodies. Investigations were performed to detect P. gingivalis, and anti-P. gingivalis antibodies. Statistical analyses were performed to confirm associations. Leptin levels in FDR were associated with BMI >25 (OR, 2.64; 95%CI, 1.17-5.97; P=0.019), radiographic damage (Simple Erosion Narrowing Score [SENS])/hands, total SENS, and joint space narrowing in feet (P=0.037, 0.026, 0.020, respectively). FDR had more tender joints (P=0.018); this finding was associated with high levels of leptin and resistin and low levels of adipsin (P=0.040, 0.040, and 0.019, respectively). The presence of P. gingivalis was related to FDR, low levels of adipsin, resistin, adiponectin, and a trend toward higher levels of leptin (P=0.002, 0.001, 0.003, and 0.060, respectively), whereas anti-P. gingivalis antibodies were related to low levels of adipsin (P=0.001). In FDR, serum adipokine levels were associated with overweight and the presence of P. gingivalis. Adipokine levels were also associated with joint involvement. Hence, adipokines may be involved in the pathogenesis of RA in FDR and warrant further investigation.

Behçet disease in Latin American countries: A systematic literature review of demographic and clinical features, and HLA-B*51 allele frequency

ObjectiveTo describe the demographic and clinical features, as well as the frequency of the HLA-B*51 allele in Behçet disease (BD) patients in Latin American countries. MethodsA systematic literature review of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines was conducted without performing a meta-analysis. We included observational studies (cross-sectional or cohort) of BD patients fulfilling the International Study Group for BD classification criteria and reported the demographic, clinical, and laboratory features of the disease in adult patients. ResultsTwelve studies were included in the SLR. Information from 532 patients across 5 Latin American countries was included for the analysis. Mean age at disease diagnosis was 33 years, 58.3% were female and 41.7% male; most patients were non-Caucasian. The most common clinical manifestations were recurrent oral ulcers and genital ulcers, followed by skin, eye, joint, neurological, gastrointestinal, vascular, and cardiac involvement. The prevalence of BD was described in 2 studies, 1 conducted in Brazil that reported a prevalence of .3/100,000 inhabitants, and another in Colombia with a prevalence of 1.1/100,000 inhabitants. The frequency of HLA-B*51 allele in BD patients was 38%, 30.1%, and 9% in Argentina, Brazil, and Mexico, respectively. ConclusionsThe prevalence of BD in the Latin American countries seems to be low, as well as the frequency of HLA-B*51 allele. However, the strength of association between HLA-B*51 and BD remains high in our population. The key clinical features of BD are like those reported in countries/regions where BD is endemic.

Retrospective analysis and preliminary laboratory validation of treatment efficacy and blood lipid levels in patients with rheumatoid arthritis.

Rheumatoid arthritis is a systemic disease characterized by progressive chronic inflammation resulting in destruction of synovial joints. In addition to joint involvement, abnormal blood lipid indexes have also been found in RA patients. The correlation between various blood lipid indexes and the treatment effects were assessed in patients with rheumatoid arthritis, for the purposes to find a better medication strategy for RA. One hundred nineteen rheumatoid arthritis patients were recruited and divided into two groups, 45 patients with significant drug treatment effect and 45 patients with insignificant drug treatment effect through the nearest neighbor matching method in propensity score. The correlation between various blood lipid indexes and drug treatment effect of rheumatoid arthritis patients was analyzed. A mouse model of rheumatoid arthritis was constructed in the laboratory; methotrexate was treated as a positive drug. We observe and record the onset of rheumatoid arthritis in mice, as well as the proportion of immune cells, the expression of inflammatory factors, and the changes in blood lipid profiles was done. The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), and erythrocyte sedimentation rate (ESR) in rheumatoid arthritis patients were significantly different between the two groups (P < 0.05). There was no significant difference in other indexes between the two groups (P > 0.05). Methotrexate had a good therapeutic effect on CIA model mice, and the levels of TC and HDL-C in the treatment group were higher than those in the model group. There is a high correlation between the levels of TC and HDL-C in rheumatoid arthritis patients and the effect of drug treatment. In the clinical treatment of rheumatoid arthritis, we should focus on improving the blood lipid indexes such as TC and HDL-C, and explore more targeted individualized administration, so as to achieve better and faster treatment effect in patients with rheumatoid arthritis. Key Points •In this research, we found that the TC and HDL-C level in RA patients' blood is highly related with the therapeutic effect, and a lower level of TC and HDL-C is better for therapeutic effect of RA.

Intraarticular management of chronic haemophilic arthropathy (Review).

Hemophilia is an inherited X-linked bleeding condition with predominant joint involvement due to intra-articular bleeding, hemosiderin deposition and the synovial hypertrophy that is responsible for cartilage destruction, joint deformity and malalignment, pain and functional restriction. Management of chronic arthropathy includes conservative and surgical approaches. Conservative therapies consist of pain modulation, oral drugs, physiotherapy and intra-articular agents. For the present review, the literature was searched for intra-articular agents and 20 papers on the use of corticosteroids (CS), hyaluronic acid (HA) and platelet-rich plasma (PRP), with different regimes of administration, were included. CS had a longer record of injection, with statistically significant pain reduction and functional improvement in the short-term and moderate persistence in the long-term. HA was able to improve the clinical and functional status of joints with moderate or severe hemophilia. PRP was relatively recently introduced to joint management and the results remain controversial. Different associations between the above-mentioned agents were proposed by studies including a small number of patients, producing comparable results. It was concluded that there is a need for extensive research on intra-articular agents, with stratification according to the severity of joint involvement. The lack of a blinded or placebo-controlled arm due to ethical aspects makes the task challenging.

The impact of psoriasis on wellbeing and clinical outcomes in juvenile psoriatic arthritis.

Juvenile PsA (JPsA) has varied clinical features that are distinctive from other JIA categories. This study investigates whether such features impact patient-reported and clinical outcomes. Children and young people (CYP) were selected if recruited to the Childhood Arthritis Prospective Study, a UK multicentre JIA inception cohort, between January 2001 and March 2018. At diagnosis, patient/parent-reported outcomes (as age-appropriate) included the parental global assessment (10 cm visual analogue scale), functional ability (Childhood Health Assessment Questionnaire (CHAQ)), pain (10 cm visual analogue scale), health-related quality of life (Child Health Questionnaire PF50 psychosocial score), mood/depressive symptoms (Moods and Feelings Questionnaire) and parent psychosocial health (General Health Questionnaire 30). Three-year outcome trajectories have previously been defined using active joint counts, physician and parent global assessments (PGA and PaGA, respectively). Patient-reported outcomes and outcome trajectories were compared in (i) CYP with JPsA vs other JIA categories and (ii) CYP within JPsA, with and without psoriasis via multivariable linear regression. There were no significant differences in patient-reported outcomes at diagnosis between CYP with JPsA and non-JPsA. Within JPsA, those with psoriasis had more depressive symptoms (coefficient = 9.8; 95% CI: 0.5, 19.0) than those without psoriasis at diagnosis. CYP with JPsA had 2.3 times the odds of persistent high PaGA than other ILAR categories, despite improving joint counts and PGA (95% CI: 1.2, 4.6). CYP with psoriasis at JPsA diagnosis report worse mood, supporting a greater disease impact in those with both skin and joint involvement. Multidisciplinary care with added focus to support wellbeing in children with JPsA plus psoriasis may help improve these outcomes.

Homoeopathy in Psoriasis Vulgaris with Special Emphasis on Modified Naranjo Criteria for Homeopathy: An Evidence-Based Case Report

Abstract Background Psoriasis is a chronic multisystem inflammatory disease with predominantly skin and joint involvement. Ample evidences suggest that psoriasis patients improve under homoeopathic treatment. The main objective of this documentation is to find out whether such improvement can be attributable to the homoeopathic treatment. Method A case of psoriasis vulgaris with the complaint of dry, scaly itching eruption on the extensor surface of both legs is presented here. Outcome-related to impact on daily living (ORIDL) was used to evaluate the patient-reported outcome related to his daily living, disease severity in the involved area was assessed by PASI (Psoriasis Area and Severity Index) scale and PDI (Psoriasis Disability Index) scale was used to assess the disease-specific quality of life. Photographs were taken as objective evidence after obtaining consent from the patient. The Modified Naranjo Criteria for Homeopathy (MONARCH) was used to find out the possible causal attribution of the treatment provided. Result The ORIDL score of (+4) showed the major improvement from patient and physician's perspective. PASI score reduced from ‘11.2 to 0’ (documented in photographs) within a plausible timeframe. The duration of remission of the skin lesion continued for six months. Each domain of PDI score reduced (from ‘25 to 3′) imparting improved quality of life. The high total score (+9 in ‘−6 to 13’ scale) of MONARCH suggested the likelihood of improvement was attributable to the homoeopathic intervention. This case has evidently shown its marked improvement with validated outcome measures.

Bahcet's Syndrome Resembling Takayasu's Arteritis with the Distribution of Arterial Involvement: A Case Report and Literature Review.

Behcet's syndrome is a variable vessel vasculitis characterized by recurrent oral and genital ulcers with concomitant skin, ocular, neurologic, gastrointestinal, and joint involvement. Herein, we present a patient who was diagnosed with Behcet's syndrome, which with magnetic resonance angiography showed occlusion of the right subclavian artery at the level of the thoracic outlet and reverse flow in the right vertebral artery consistent with subclavian steal syndrome. In addition, partial narrowing was noted in the left renal artery. The distribution of arterial involvement resembled Takayasu's arteritis, although the presence of mucocutaneous lesions, male gender, history of deep vein thrombosis, and HLA-B51 positivity favored a diagnosis of vasculo-Behçet's syndrome. We treated the patient with methylprednisolone and cyclophosphamide. After the regression of vascular inflammation with immunosuppressive therapy, stenting was performed in the left renal artery.

Short-term outcome of patients with adult IgA vasculitis: a single-center experience.

Follow-up data on IgA vasculitis (IgAV) in adults are scarce. We aimed to investigate the outcome of adult IgAV in a well-defined cohort. Data from histologically proven patients diagnosed between January 2010 and July 2022 with at least a 3-month follow-up were analyzed. The frequency and type of relapses and information on kidney function were extracted. Risk factors for IgAV relapse and decline in renal function were studied using the Cox hazards regression analysis. Mortality in IgAV was assessed using the Kaplan-Meier analysis and the standardized mortality ratio (SMR). In total, 265 patients were followed for a median of 24 months. At baseline, 38.9, 29.8, and 44.5% had articular, gastrointestinal, and renal involvement, respectively. Initially, 189 (71.3%) patients received systemic glucocorticoids, and 32 (12.1%) patients received an additional immunomodulator. During follow-up, 42 (15.8%) patients relapsed. Relapses were more common in younger patients (HR 1.03 [95%CI 1.01-1.05]) and those without baseline glucocorticoid treatment (HR 3.70 [95%CI 2.0-6.67]). Furthermore, 74 (27.9%) patients had persistent abnormal urinalysis and a substantial (≥20%) decline in glomerular filtration rate (eGFR) was recorded in 41 (15.5%) patients. The factors associated with persistent abnormal urinalysis were an absence of IgAV joint involvement and baseline immunomodulatory treatment. Pre-existent chronic kidney disease and heart failure were associated with eGFR decline. The overall SMR was 1.4 (95%CI 1.14-1.71) compared to the Slovenian general population. IgAV relapses occurred in 15% of patients, with younger patients with symptomatically managed IgAV experiencing it more frequently. Heart failure emerged as a predictor of persistent abnormal urinalysis and a decline in eGFR. Adults with IgAV had increased mortality compared to the general population.

Outcome analysis of fracture lower end radius (Ao Type B &amp; C) treated by ORIF and plate

Treatment of distal radius fractures is difficult due to comminution and joint involvement. Plating is now the standard treatment method for distal radius articular fractures because of higher rate of complications after conservative management. The aim of the study was to evaluate the usefulness of volar lokcing plate fixation method of distal radius fracture and to compare it with other results.We ealuated 28 patients from volar locking plates from December2012 to March 2017, treated for distal radius intraartiular fractures by using a volar locking compression plate. Standard X-ray and clinical assessment after 1year were measured and final outcome were assessed using modified Gartland and Werley score. At the end of 12 months, 17 cases out of 28 cases in which most of the excellent results in AO type B fractures (excellent oucome in 13patients out of 16patients i.e. 81.25% cases) as compared to type C fracture where it was 33.33% cases (excellent outcome in 4patients out of 12patients). One case developed of superficial wound infection which resolves with antibiotics. The distal radius fixation volar locking plate restores anatomy, helps in speedy movement of wrist and function, prevents postoperative collapse of fracture and hence is an excellent treatment method for distal radius fractures.

JAK Inhibition in Juvenile Idiopathic Arthritis (JIA): Better Understanding of a Promising Therapy for Refractory Cases.

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases with probably differential underlying physiopathology. Despite the revolutionary era of biologics, some patients remain difficult to treat because of disease severity, drug adverse events, drug allergy or association with severe comorbidities, i.e., uveitis, interstitial lung disease and macrophagic activation syndrome. Janus Kinase (JAK) inhibitors are small molecules that target JAK/Signal Transducers and Activators of Transcription (STAT) pathways, which could then prevent the activity of several proinflammatory cytokines. They may provide a useful alternative in these cases of JIA or in patients actually affected by Mendelian disorders mimicking JIA, such as type I interferonopathies with joint involvement, and might be the bridge for haematopoietic stem cell transplantation in these disabling conditions. As these treatments may have side effects that should not be ignored, ongoing and further controlled studies are still needed to provide data underlying long-term safety considerations in children and delineate subsets of JIA patients that will benefit from these promising treatments.

Eccentric Resistance Training: A Methodological Proposal of Eccentric Muscle Exercise Classification Based on Exercise Complexity, Training Objectives, Methods, and Intensity

Eccentric resistance training that focuses on the lengthening phase of muscle actions has gained attention for its potential to enhance muscle strength, power, and performance (among others). This review presents a methodological proposal for classifying eccentric exercises based on complexity, objectives, methods, and intensity. We discuss the rationale and physiological implications of eccentric training, considering its benefits and risks. The proposed classification system considers exercise complexity and categorizing exercises by technical requirements and joint involvement, accommodating various skill levels. Additionally, training objectives are addressed, including (i) Sports Rehabilitation and Return To Sport, (ii) Muscle Development, (iii) Injury Prevention, (iv) Special Populations, and (v) Sporting Performance, proposing exercise selection with desired outcomes. The review also highlights various eccentric training methods, such as tempo, isoinertial, plyometrics, and moderate eccentric load, each with different benefits. The classification system also integrates intensity levels, allowing for progressive overload and individualized adjustments. This methodological proposal provides a framework for organizing eccentric resistance training programs, facilitating exercise selection, program design, and progression. Furthermore, it assists trainers, coaches, and professionals in optimizing eccentric training’s benefits, promoting advancements in research and practical application. In conclusion, this methodological proposal offers a systematic approach for classifying eccentric exercises based on complexity, objectives, methods, and intensity. It enhances exercise selection, program design, and progression in eccentric resistance training according to training objectives and desired outcomes.

Systemic lupus erythematosus-related acute lung disease.

Systemic lupus erythematosus (SLE) is non-organ specific autoimmune disease with mainly skin, joint, and kidney involvement. SLE-related acute lung disease (ALD) is rare, poorly investigated and can lead to acute respiratory failure. We conducted a retrospective study aiming to describe clinical features, treatments and outcome of SLE-related APD. We retrospectively included all patients with SLE and ALD admitted from November 1996 and September 2018 to La Pitié-Salpêtrière Hospital, after exclusion of viral or bacterial lung infection, cardiac failure or any other alternate diagnosis. During the time of the study, 14 patients with 16 episodes were admitted to our center: female 79%, mean age ± SD at admission 24 ± 11years. ALD was inaugural of the SLE in 70% cases. SLE main organ involvement were: arthritis 93%, skin 79%, serositis 79%, hematological 79%, kidney 64%, neuropsychiatric 36% and cardiac 21%. 11 episodes required ICU admission for a median time of 8days. Chest CT-scan revealed mostly basal consolidation and ground-glass opacities. When available, bronchoalveolar lavage mostly revealed a neutrophilic alveolitis with alveolar hemorrhage in 67% cases. Symptomatic respiratory treatments were: oxygen 81%, high-flow nasal canula oxygen 27%, non-invasive ventilation 36%, mechanical ventilation 64% and venovenous extracorporeal membrane oxygenation 18%. SLE-specific treatments were: corticosteroids 100%, cyclophosphamide 56% and plasma exchange 25%. All patients but one survived to ICU and hospital discharge. Two patients had a relapse of SLE-related ALD but none had interstitial lung disease during follow-up. Systemic lupus erythematosus-related acute respiratory failure is a severe event, mostly occurring at SLE onset, typical harboring a basal consolidation pattern on chest CT-scan and alveolar hemorrhage on BAL pathological examination. Mortality in our cohort is lower than previously reported but these results needs to be confirmed in further larger studies.

Temporomandibular joint involvement in patients with Juvenile Idiopathic Arthritis: comparison of ultrasonography and magnetic resonance imaging in assessing the periarticular space width

ObjectivesThis study aimed to compare the performance of Ultrasonography (US) and Magnetic Resonance Imaging (MRI) in assessing the Lateral Periarticular Space (LPAS) of Temporomandibular Joints (TMJs) in patients with Juvenile Idiopathic Arthritis (JIA).MethodsThe LPAS width was evaluated in two different patient groups. In the JIA group, including 29 children (13 ± 2.8 years) with JIA, the LPAS width was measured with both MRI and US. In the healthy group, including 28 healthy children (12.6 ± 2.5 years), the LPAS width was measured only with US. Comparisons of LPAS width based on patient groups and TMJ contrast enhancement in MRI were evaluated by applying the Mann–Whitney U test. Correlation and agreement between MRI and US measurements in JIA group were tested using Spearman rank correlation and Bland–Altman method.ResultsThe LPAS width was significantly greater in the JIA group than in the healthy group. In the JIA group, the LPAS width was significantly greater in TMJs with moderate/severe enhancement than those with mild enhancement. A positive significant correlation between MRI and US measurements of LPAS width was found in the JIA group. In the same group, Bland–Altman method showed a good level of agreement between MRI and US measurements.ConclusionAlthough, US cannot replace MRI in the evaluation of TMJ in patients with JIA, US could be used as a supplementary imaging method to MRI in assessing the TMJ disease.

Radiosynovectomy of the hip joint - preliminary experience.

Radiosynovectomy (RSV) is a minimally invasive method of treating and controlling joint inflammation refractory to conventional pharmacotherapy. It consist in intraarticular injection of radioactive colloids which irradiate the inflamed synovial membrane to cause its subsequent involution. Despite the fact that hip joint involvement is quite common in systemic inflammatory arthropathies, hip joint RSVs are rarely performed. The aim of this paper is to assess to safety and efficacy of hip joint radioisotope treatment. We retrospectively analyzed the effects of 21 hip joint RSVs performed in 14 patients (10 female, 4 male; aged 8 to 79; mean age 48 years). Before the RSV, all the patients underwent clinical and ultrasound examination. The radiosynovectomies were performed using rhenium-186 sulfide under ultrasound guidance. Each patient underwent post-therapeutic scintigraphy to assess intraarticular distribution of the radiopharmaceutical. The effects of the treatment were assessed clinically and ultrasonographically during at least 2 follow-up visits 3 and 6 months after the RSV. In 9 cases, we observed complete resolution of symptoms 3 and 6 months after the RSV. Four patients had only a partial response and required repeated treatment, and all responded well to the second RSV. In 4 patients the treatment had no significant effect, and no repeated treatment attempt was made. All the responders suffered from inflammatory arthropathies; the non-responders had osteoarthritis, with no history of systemic diseases. In all the patients, no significant adverse effects were observed; in particular there were no radiation burns or infections. All post-therapeutic scintigrams showed proper, intraarticular distribution of the radiopharmaceutical. Radiosynovectomy of the hip joint in systemic joint diseases, especially performed using ultrasound-guidance, is a safe and effective treatment modality.

Nail Psoriasis: An Updated Review of Currently Available Systemic Treatments.

Nail psoriasis (NP) has a prevalence that ranges from 10 to 82% among patients with psoriasis (PsO) and is one of the most common difficult to treat site of psoriasis. We performed a thorough review of the literature, exploring evidence regarding all available NP systemic treatments, describing also in detail NP dedicated clinical trials. A literature search was conducted in PubMed and Embase prior to February 2023 using a combination of the terms "nail" AND "psoriasis" AND "systemic therapy" AND/OR "systemic treatment". A total of 47 original studies and case reports were reviewed in this article. Systemic therapies should be considered when the disorder involves more than 3 nails, has extensive skin and joint involvement, and has a significant impact on QoL, due to their best long-term efficacy. In detail, conventional and biologic systemic drugs demonstrated efficacy in recent trials, including acitretin, methotrexate, cyclosporine, apremilast, adalimumab, infliximab, etanercept, certolizumab, golimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, bimekizumab, guselkumab, risankizumab and tildrakizumab. Several therapies have demonstrated efficacy and safety in the treatment of NP; however, the choice of treatment depends not only on the severity of the nail involvement, but also on whether PsA is present, the patient's comorbidities other than PsA, previous treatment history, and the patient's drug preferences.