Median Erythrocyte Sedimentation Rate Research Articles

Simultaneous Single-Position Oblique Lateral Interbody Fusion Combined With Unilateral Percutaneous Pedicle Screw Fixation for Single-Level Lumbar Tuberculosis: A 3-Year Retrospective Comparative Study.

To illustrate a simultaneous single-position oblique lateral interbody fusion (SPOLIF) combined with unilateral percutaneous pedicle screw fixation in treating single-level lumbar tuberculosis, compared with posterior-only approach in clinical and radiographic evaluations. Consecutive patients who had undergone surgeries for single-level lumbar tuberculosis from January 2018 to December 2020 were retrospectively reviewed. The patients included were divided into SP-OLIF and posterior-only groups according to surgical methods applied, with follow-up for at least 36 months. Outcomes included estimated blood loss, operative time, and complications for safety evaluation; visual analogue scale (VAS), Oswestry Disability Index (ODI) for efficacy evaluation; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) for evaluating tuberculosis activity; x-ray and computed tomography scan were used for radiographic evaluation. A total of 136 patients had been enrolled in the study (60 for SP-OLIF and 76 for Posterior-only). The median operative time, blood loss, and hospital stay in SP-OLIF group were significantly less, with a lower complication rate. Meanwhile, the SP-OLIF group showed substantially lower VAS in 1 and 7 days and decreased ODI in the first month postoperatively, without significant difference afterward. Similarly, the median CRP and ESR in SP-OLIF group were significantly lower in 3 and 7 days postoperatively. All indicators had reduced to normal after 3 months. No recurrence had been reported throughout the whole follow-up. SP-OLIF was an efficient minimally invasive protocol for single-level lumbar tuberculosis, facilitating earlier clinical improvement, with decreased blood loss, operative time and hospital stay compared with posterior-only approach.

Disease spectrum of myopathies with elevated aldolase and normal creatine kinase.

Elevation of serum creatine kinase (CK) or hyperCKemia is considered a biological marker of myopathies. However, selective elevation of serum aldolase with normal CK has been reported in a few myopathies, including dermatomyositis, immune-mediated myopathy with perimysial pathology and fasciitis with associated myopathy. The aim was to investigate the disease spectrum of myopathies with isolated aldolase elevation. Medical records were reviewed to identify patients >18 years old seen between December 1994 and June 2020 who had pathologically proven myopathies with elevated aldolase and normal CK level. Patients with alternative causes of aldolase elevation were excluded. Thirty-four patients with various types of myopathies were identified. Myopathies were treatable in 27 patients. The three most common etiologies were dermatomyositis (n = 8), overlap myositis (n = 4) and nonspecific myopathy (n = 4). Perimysial pathology comprising inflammation, fragmentation, vasculitis, calcified perimysial vessels or extracellular amyloid deposition was found in 17/34 patients (50%). Eight dermatomyositis patients with selective elevated aldolase were compared to 24 sex- and age-matched patients with dermatomyositis and hyperCKemia. Dermatomyositis patients with normal CK significantly (p < 0.05) had less frequent cutaneous involvement (50.0% vs. 100.0%) and fibrillation potentials (50.0% vs. 90.5%) but higher median erythrocyte sedimentation rate (33.5 vs. 13.5 mm/h) and more common perifascicular mitochondrial pathology (37.5% vs. 4.2%). Isolated aldolase elevation can be found in a greater variety of myopathies than initially thought and most were treatable. Dermatomyositis is the most common myopathy with selective elevation of aldolase in our cohort, which features some unique characteristics compared to dermatomyositis with hyperCKemia.

E19 Gamma-glutamyl transpeptidase level is correlated with disease activity in oligoarticular and polyarticular Juvenile idiopathic arthritis

Abstract Introduction Gamma-glutamyl transpeptidase (GGT) level was found to be correlated with disease activity indexes in rheumatoid arthritis [1]. This association was not yet investigated in children with oligoarticular and polyarticular Juvenile idiopathic arthritis (JIA). Objectives The present study aims to investigate the correlation between GGT level and disease-related parameters in oligoarticular and polyarticular JIA. Methods We performed a retrospective study including patients with oligoarticular and polyarticular JIA responding to the 2001 International League of Associations for Rheumatology (ILAR) classification. Sociodemographic, disease-related parameters (age of onset, disease duration, patient global assessment (PGA), Pain Visual Analogue Scale (VAS), C-Reactive protein (CRP) level, Erythrocyte Sedimentation Rate (ESR), disease activity assessed using the Juvenile Arthritis Disease Activity Score (JADAS) based on ESR), and GGT level were collected. Continuous variables were expressed with median and Interquartile range (IQR). Spearman correlation was used to assess the association between GGT levels and disease-related data. Results Eleven patients were included with a median age of 12 (IQR: 10–15) years and 8 females. Median disease duration was 4 (IQR: 4–7) years and median age of onset was 8 (IQR: 5–10) years. Five patients had oligoarticular JIA, 3 had a polyarticular with positive Rheumatoid Factor (RF) form, 2 had a polyarticular with negative RF form and one had an undifferentiated JIA. Median JADAS was 3.6 (IQR: 0–9). Median ESR, CRP, and GGT levels were 14 (10–19) mm/H, 1.8 (2–6.4) mg/l, and 14 (12–16) IU/l, respectively. A strong positive correlation was found between GGT level and JADAS (r = 0.749, P = 0.008). Level of CRP and ESR were not correlated with GGT level. Besides, patient global assessment and pain VAS were positively correlated with GGT level (r = 0.670, P = 0.049; r = 0.814, P = 0.014, respectively). No correlation was found between GGT level and disease duration and number of tender or swollen joints. Conclusion The GGT level was significantly higher in patients with more active disease, higher pain, and global assessment. This suggests that GGT level can be used as a marker of disease activity as in JIA. References 1 Vergneault H, Vandebeuque E, Codullo V, Allanore Y, Avouac J. Disease Activity Score-28 using γGT permits a dual evaluation of joint activity and cardiovascular risk. J Rheumatol 2020.

Giant cell arteritis with vertebral artery involvement-baseline characteristics and follow-up of a monocentric patient cohort.

Vertebral artery (VA) involvement in giant cell arteritis (GCA) has rarely been reported. We aimed to evaluate the prevalence, patients' characteristics, and immunotherapies used in patients with GCA and VA involvement at diagnosis and 1 year follow-up, retrospectively including patients being diagnosed between January 2011 and March 2021 in our department. Clinical features, laboratory data, VA imaging, immunotherapy, and 1 year follow-up data were analyzed. Baseline characteristics were compared to GCA patients without VA involvement. Among all 77 cases with GCA, 29 patients (37.7%) had VA involvement, as diagnosed by imaging and/or clinical signs and symptoms. Gender distribution and erythrocyte sedimentation rate (ESR) were significantly different in the groups with and without VA involvement, with more women being affected (38/48 patients, 79.2%) and a significantly higher median ESR in patients without VA involvement (62 vs. 46 mm/h; p = 0.012). MRI and/or CT showed vertebrobasilar stroke at GCA diagnosis in 11 cases. 67/77 patients (87.0%) received high-dose intravenous glucocorticosteroids (GCs) at diagnosis, followed by oral tapering. Six patients were treated with methotrexate (MTX), one with rituximab, and five with tocilizumab (TCZ). 2/5 TCZ patients achieved clinical remission after 1 year, vertebrobasilar stroke within the first year occurred in 2/5 patients. Diagnosis of VA involvement might be underrecognized in GCA patients. VA imaging should be performed in elderly patients with vertebrobasilar stroke presenting with GCA symptoms, not to miss GCA as the etiology of stroke. Efficacy of immunotherapies in GCA with VA affection and long-term outcomes need to be investigated further.

Multisystem Inflammatory Syndrome in Children Associated with COVID-19 Infection: Clinical Presentation and Outcome

Abstract Objective In the midst of the COVID-19 pandemic, many children presenting with persistent fever, rashes, conjunctivitis, abdominal pain, respiratory distress, and shock were reported and diagnosed with multisystem inflammatory syndrome in children (MIS-C). The aim of the study was to observe the clinical presentation and outcome of MIS-C treated at a tertiary care hospital. Methods Eighteen children, aged 24 days to 18 years, with suspected MIS-C were admitted. Their clinical presentation, laboratory parameters, radiological investigations, management, and outcomes were recorded. Results Median age was 8 years (interquartile range [IQR]: 0.5, 14), and the male-to-female ratio was 1:1. Fever, tachycardia, respiratory distress, hypotension, and seizures with altered sensorium were present in 94.4, 88.8, 83.3, 44.4, and 44.4% of the cases, respectively. Median erythrocyte sedimentation rate, C-reactive protein, serum ferritin, and d-Dimer levels were 21 mm/h, 151 mg/L (1,14.2, 319), 1,091 µg/L (737.4, 1,456), and 3,094 ng/mL (990, 4,300), respectively. Methylprednisolone was given to all patients. Low molecular weight heparin and intravenous immunoglobulin (IVIG) were instituted in 83.3 and 38.8% cases, respectively. Seventeen patients (94.4%) required oxygen therapy and 44.4% needed mechanical ventilation. Fourteen patients (77.7%) recovered completely and four cases (22.2%) expired during the hospital stay. The need for ventilation and the presence of shock adversely affected the outcome. Conclusion Chief clinical presentations in the patients of MIS-C were fever, respiratory distress, hypotension, and altered sensorium. Among admitted patients, 87.8% cases were managed successfully by systemic corticosteroids with or without IVIG. Need for mechanical ventilation, shock, and central nervous system symptoms at admission appear to be important factors that can lead to mortality.

Plasma D-Dimer Is a Promising Marker to Guide Timing of Reimplantation: A Prospective Cohort Study

BackgroundTwo-stage exchange arthroplasty remains the preferred surgical treatment for chronic periprosthetic joint infection. Currently, there is no single reliable marker to determine the optimal timing for reimplantation. The purpose of this prospective study was to assess the diagnostic utility of plasma D-dimer and other serological markers in predicting successful control of infection following reimplantation. MethodsThis study enrolled 136 patients undergoing reimplantation arthroplasty between November 2016 and December 2020. Strict inclusion criteria were applied including the need for a two-week “antibiotic holiday” prior to reimplantation. A total of 114 patients were included in the final analysis. Plasma D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen were measured preoperatively. Treatment success was defined using the Musculoskeletal Infection Society Outcome-Reporting Tool. Receiver operating characteristic curves were used to assess the prognostic accuracy of each biomarker in predicting failure following reimplantation at a minimum 1-year follow-up. ResultsTreatment failure occurred in 33 patients (28.9%) at a mean follow-up of 3.2 years (range, 1.0 to 5.7). Median plasma D-dimer was significantly higher in the treatment failure group (1,604 versus 631 ng/mL, P < .001), whereas median CRP, ESR, and fibrinogen were not significantly different between the success and failure groups. Plasma D-dimer demonstrated the best diagnostic utility (area under the curve [AUC] 0.724, sensitivity 51.5%, specificity 92.6%), outperforming ESR (AUC 0.565, sensitivity 93.3%, specificity 22.5%), CRP (AUC 0.541, sensitivity 87.5%, specificity 26.3%), and fibrinogen (AUC 0.485, sensitivity 30.4%, specificity 80.0%). Plasma D-dimer level of ≥1,604 ng/mL was identified as the optimal cutoff that predicted failure following reimplantation. ConclusionPlasma D-dimer was superior to serum ESR, CRP, and fibrinogen in predicting failure after the second stage of a two-stage exchange arthroplasty for periprosthetic joint infection. Based on the findings of this prospective study, plasma D-dimer may be a promising marker in assessing the control of infection in patients undergoing reimplantation surgery. Level of evidenceLevel II.

Monocyte-to-HDL Cholesterol Ratio As A New Parameter of Systemic Inflammation and Disease Severity in Treatment-Resistant Chronic Spontaneous Urticaria

Background and Purpose: Chronic spontaneous urticaria (CSU) is characterized by inflammation and increased oxidative stress in its pathogenesis. The study aims to evaluate new inflammatory markers indicating systemic inflammation in resistant CSU and to determine their relationship with disease severity.&#x0D; Methods: The files of CSU patients and matched healthy volunteers were reviewed and compared in terms of demographics, medical history, clinical features, laboratory parameters, and new inflammatory markers [NLR:neutrophil-lymphocyte ratio, MLR: monocyte-lymphocyte ratio, MHR:monocyte-to-high-density lipoprotein cholesterol (HDL-C)].&#x0D; Results: Sixty-one CSU patients and 50 healthy controls were evaluated (female: male ratio=1.9:1, mean age=43.97 ± 14.88 years). The median erythrocyte sedimentation rate, C-reactive protein (CRP), white blood cell, monocyte count, and MHR were higher in the CSU group; in contrast, the mean HDL-C level was lower. The median NLR and MLR were also higher in the CSU group but were not statistically significant. Urticaria activity score 7 (UAS7) was positively correlated with MHR and negatively correlated with HDL-C. MHR was positively correlated with MLR, CRP, and UAS7.&#x0D; Conclusions: MHR might serve as an indicator of inflammation intensity and predisposition to MS in CSU patients. It might also be used as an objective tool for evaluating disease severity and treatment response in CSU.

Clinical characteristics and the influence of rs1800470 in patients with Camurati-Engelmann disease.

Camurati-Engelmann disease (CED) is a sclerosing bone dysplasia caused by transforming growth factor β1 (TGFB1) gene variants. We aim to summarize the clinical characteristics and the efficacy of glucocorticoids in 14 individuals with CED, and explore the correlation between the phenotype and the SNP of rs1800470 (c.29C>T). Clinical, biochemical, radiological, and therapeutic data were collected from 14 patients. DNA was extracted for TGFB1 variants detection by Sanger sequencing. The median onset and record age were 3.0 and 16.1 years, respectively. All patients manifested bone pain and decreased subcutaneous fat tissue. Inflammatory markers increased in over 60% of patients, and the median erythrocyte sedimentation rate (ESR) was 1.40 (0.50~3.67) of the upper limit of normal (ULN), and the median high sensitivity C reactive protein (hsCRP) was 1.71 (0.48~12.56) of ULN. There was a positive correlation between ESR and hsCRP (rs=0.806, p=0.003). Both ESR and hsCRP were negatively correlated with the levels of hemoglobin (HGB), calcium, and creatinine, but positively correlated with the level of alkaline phosphatase. Four known variants of TGFB1 were identified, including p.Tyr171Cys, p.Arg218Cys, p.Arg218His, and p.Cys225Arg. Moreover, 35.7% and 28.6% of them carried the heterozygous and homozygous SNP of c.29C>T, called C/T and T/T groups, respectively, but 35.7% of them were without c.29C>T (C/C group). The onset age, anthropometric data, percentages of different clinical manifestations, and biochemical parameters were comparable among the three groups. But there were increasing trends in levels of HGB and calcium and decreasing trends in ESR and hsCRP among C/C, C/T, and T/T groups in turn. Glucocorticoid improves the two inflammatory markers among CED patients. The phenotype of CED is highly heterogeneous. There is no clear genotype-phenotype correlation, but it seems to have better trends of biochemical parameters in patients with CED carrying the T allele of rs1800470.

LOW CD8+ COUNT CORRELATION WITH INFLAMMATORY MARKERS IN ACUTE COVID-19

LOW CD8+ COUNT CORRELATION WITH INFLAMMATORY MARKERS IN ACUTE COVID-19

Predictors of Reinfection in Prosthetic Joint Infections Following Two-Stage Reimplantation.

Two-stage reimplantation is an effective treatment for periprosthetic joint infection (PJI). Many factors are involved in the variable success of this procedure. The purpose of this study is to examine the relationship between patient risk factors, comorbidities, and the pathogen on reinfection rates following two-stage reimplantation. We evaluated 158 patients treated for PJI from 2008-2019. Only patients who had completed a two-stage exchange were included. Patient demographics, comorbidities, laboratory values, time-to-reimplantation, pathogen, antibiotic sensitivities, host status, and reinfection rates were assessed. Multivariate analysis was performed to identify correlation between risk factors and reinfection. A P-value < .05 was considered statistically significant. 31 patients experienced a reinfection (19.6%). There was a statistically significant association between infection with Methicillin Sensitive Staphylococcus Aureus (MSSA) and reinfection (P= .046). Patients with a reinfection also had a significantly greater median serum C-reactive protein (CRP) level (12.65 g/dL) at the time of diagnosis compared to patients without a reinfection (5.0 g/dL) (P= .010). Median Erythrocyte Sedimentation Rate (ESR) (56 in no re-infection and 69 in re-infection) and time-to-reimplantation (101 days in no reinfection and 141 days in reinfection) demonstrated a trend toward an association with re-infection but were not statistically significant (P= .055 and P= .054 respectively). As the number of arthroplasties continue to rise, PJIs are increasing proportionately and represent a significant revision burden. Elevated C-reactive protein (CRP) levels and Methicillin Sensitive Staphylococcus aureus (MSSA) infection were strongly associated with failure of a two-stage reimplantation. While not statistically significant with our numbers, there were strong trends toward an association between elevated Erythrocyte Sedimentation Rate (ESR), longer time-to-reimplantation, and reinfection.

POS1377 LUNG INVOLVEMENT IN VEXAS SYNDROME

BackgroundVacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a recently identified disorder caused by somatic mutations in the UBA1 gene of myeloid cells. Various manifestations of pulmonary involvement have been reported, but a detailed description of lung involvement and radiologic findings is lacking.ObjectivesTo describe lung involvement in VEXAS syndrome.MethodsA retrospective cohort study was conducted of all patients identified at the Mayo Clinic with VEXAS syndrome since October 2020. Clinical records and chest high resolution computed tomography (HRCT) scans were reviewed.ResultsOur cohort comprised 22 white men with a median age of 69 years (IQR 62-74, range 57-84). Hematologic disorders including multiple myeloma, myelodysplastic syndrome and pancytopenia were present in 10 patients (45%), rheumatologic diseases including granulomatosis with polyangiitis, IgG4-related disease, polyarteritis nodosa, relapsing polychondritis, and rheumatoid arthritis were found in 10 patients (45%), and 4 patients had dermatologic presentations including Sweet syndrome, Schnitzer-like syndrome or drug rash with eosinophilia skin syndrome (DRESS). VEXAS syndrome-related features included fever (18, 82%), skin lesions (20, 91%), lung infiltrates (12, 55%), chondritis (10, 45%), venous thromboembolism (12, 55%), macrocytic anemia (21, 96%), and bone marrow vacuoles (21, 96%). Other manifestations observed were arthritis, scleritis, hoarseness and hearing loss. Median erythrocyte sedimentation rate (ESR) was 69 mm/1st hour (IQR 34.3-118.8) and median C-reactive protein (CRP) of 55.5 mg/dL (IQR 11.4-98.8). The somatic mutations affecting methionine-41 (p.Met41) in UBA1 gene were: 11 (50%) p.Met41Thr, 7 (32%) p.Met41Val, 2 (9%) p.Met41Leu, and 2 (9%) in the splice site. All patients received glucocorticoids (GC) (median duration of treatment was 2.6 years); 21 (96%) received conventional immunosuppressive agents (methotrexate, azathioprine, mycophenolate, leflunomide, cyclosporin, hydroxychloroquine, tofacitinib, ruxolitinib) and 9 (41%) received biologic agents (rituximab, tocilizumab, infliximab, etanercept, adalimumab, golimumab, abatacept). Respiratory symptoms included dyspnea and cough present in 21 (95%) and 12 (55%), respectively, and were documented prior to VEXAS diagnosis. Most of the patients were non-smokers (14, 64%) and obstructive sleep apnea (OSA) was present in 11 patients (50%). Seven patients (32%) used non-invasive ventilation, 6 used C-PAP, and 1 used Bi-PAP. Bronchoalveolar lavage (BAL) was available in 4 patients, and the findings were compatible with neutrophilic alveolitis in 3. Two patients had lung biopsies (2 transbronchial and 1 surgical) that showed ATTR amyloidosis and organizing pneumonia with lymphoid interstitial pneumonia, respectively. Pulmonary function tests were available in 9 (41%) patients and showed normal results in 5; 3 patients had isolated reduction in DLCO and 1 with mild restriction. On chest HRCT, 16 patients (73%) had parenchymal changes including ground-glass opacities in 9, septal thickening in 4, and nodules in 3; pleural effusions were present in 3 patients, air-trapping in 3 patients and tracheomalacia in 1 patient. Follow-up chest HRCT was available for 8 patients (36%), the ground-glass opacities resolved in 5 patients, 3 patients manifested new or increased ground-glass opacities, and 1 patient had increased interlobular septal thickening. After 1 year of follow-up, 4 patients (17%) had died; 3 due to pneumonia (2 COVID-19,1 bacterial) and 1 due to heart failure. VEXAS flares occurred in 18 patients (82%), the maximum number of relapses was 7, and they were mainly managed with GC and with changes in the immunosuppressive regimen.ConclusionPulmonary involvement was documented by chest HRCT in most patients with VEXAS syndrome. Respiratory symptoms occurred in over one half of patients and about 20% had PFT abnormalities. The pulmonary manifestations of VEXAS are nonspecific and characterized predominantly by inflammatory parenchymal involvement.Disclosure of InterestsNone declared

Albumin to Globulin ratio, Neutrophil to Lymphocyte ratio, and Globulin levels do not outperform ESR or CRP when diagnosing periprosthetic joint infection

ObjectiveTo evaluate the relative performance of clinical readouts including serum C-reactive protein (CRP) levels, the erythrocyte sedimentation rate (ESR), globulin (GLB) levels, the albumin to GLB ratio (A/G), and the neutrophil to lymphocyte ratio (NLR) when diagnosing periprosthetic joint infection (PJI).MethodsClinical data was collected from 115 individuals diagnosed in our department between January 2017 and December 2020 with either chronic PJI (29 female, 24 male; median age 71.00 years [range, 41–94 years]) or aseptic loosening (30 female, 32 male; median age 68.50 years [range, 34–85 years]). Patient demographic data were compared, and the relative sensitivity and specificity of preoperative GLB, ESR, CRP, NLR, and A/G values as predictors of PJI diagnosis were assessed.ResultsMedian globulin levels in the PJI and aseptic groups were 31.700 g/L (interquartile range [IQR], 28.400—35.300) and 26.600 g/L (IQR, 24.375—30.550), respectively (p < 0.001). The median A/G values in the PJI and aseptic groups were 1.150 (IQR, 0.960—1.255) and 1.510 (IQR, 1.265—1.670), respectively (p < 0.001). The median NLR values in the PJI and aseptic groups were 2.510 (IQR, 1.900—3.335) and 1.850 (IQR, 1.425 to 2.362), respectively (p < 0.001). The median ESR values in the PJI and aseptic groups were 53.000 mm/h (IQR, 35.000—76.500) and 16.000 mm/h (IQR, 7.000—33.000), respectively (p < 0.001). Median CRP levels in the PJI and aseptic groups were 24.890 mg/L (IQR, 10.595—54.095) and 2.245 mg/L (IQR, 0.865—8.6075), respectively (p < 0.001). Area under the receiver operating characteristic (ROC) curve (AUC) values for CRP, ESR, GLB, A/G, and NLR were 0.841 (95% confidence interval, 0.761–0.903), 0.850 (0.771–0.910), 0.747 (0.658–0.824), 0.779 (0.692–0.851), and 0.708 (0.616–0.789), respectively. When GLB > 26.6 g/L, A/G < 1.32, and NLR > 2.1 were utilized as threshold values to diagnose PJI, GLB and A/G were found to exhibit superior sensitivity (90.57%, 81.13%) to that observed for CRP (71.70%) and ESR (79.25%), but the specificity of these two metrics (GLB: 51.61%, A/G: 72.58%) was significantly reduced relative to that for CRP (87.10%) or ESR (75.81%). ROC analyses further revealed that NLR did not exhibit significant advantages in sensitivity (73.58%) or specificity (70.97%) relative to CRP or ESR.ConclusionGlobulin levels, NLR values, and A/G values do not outperform ESR or CRP levels when used to diagnose PJI.

Establishment and Evaluation of an Internal Quality Control Method for ESR Relays.

ObjectiveThis study establish and evaluate an internal quality control system for erythrocyte sedimentation rate (ESR) by a “relay” mode based on samples from relevant patients.MethodsThe method for establishing a new internal quality control system for ESR by a “relay” mode based on patient’s samples was executed from February 2021 to July 2021. In this paper, a total of 219 outpatients were recruited for ESR determination, and their blood samples were stored at 4 °C or room temperature for 24 h. Subsequently, the samples were re-measured for ESR, and the re-measured values were compared with the initial values. The patient samples (15±1mm/h and 50±3mm/h) were selected after the TEST1 ESR analyzer was calibrated, and were stored overnight at 4 °C and measured again the following day. The percentage deviation was determined and entered into the quality control management module for internal quality control. Next, we analyzed the median distribution trend of the patients’ ESR values measured by our laboratory every day over five months, as well as the external quality assessment (EQA) results for ESR obtained from the National Center for Clinical Laboratories (NCCL).ResultsThe ESR of the room temperature samples after 24 h of storage had significantly decreased (P=0.001), while there was no noticeable difference for those stored at 4 °C (P=0.197). Results of the internal quality control in March were satisfactory, and there was no significant deviation in the median ESR relay results within five months. Besides, the EQA results for the ESR data obtained from NCCL were excellent.ConclusionAs a precise and practical new method, the ESR relay internal quality control method can be used to scientifically determine the stability and accuracy of the TEST1 ESR analyzer.

Do Pre-Reimplantation Erythrocyte Sedimentation Rate/C-Reactive Protein Cutoffs Guide Decision-Making in Prosthetic Joint Infection? Are We Flying Blind?

Two-stage exchange is a commonly used approach for treating chronic periprosthetic joint infections (PJI). A pre-reimplantation threshold value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to determine infection eradication and the proper timing of reimplantation remains ill-defined. We retrospectively reviewed 483 potential patients for eligibility. In total, 178 patients were excluded. In addition, 305 joints were eligible who underwent 2-stage revision for prosthetic hip or knee joint infection (PJI). Serum ESR and CRP were recorded at 8 weeks post resection prior to stage 2 reimplantation. ESR and CRP were analyzed with receiver operating characteristic curves (ROC) for response failure. In total, 252 patients had resections for chronic infections while 53 septic patients had resections for acute infections. Forty-one of 252 (16.3%) patients failed reimplantation. Median ESR at the time of reimplantation was 17 (normal less than 20 mm/h). Median CRP was 0.6 (normal less than 0.5 mg/dL). ROC plot for response failure in analyzing ESR found an area under the curve (AUC) of 0.47. ROC plot analyzing CRP found an AUC of 0.57. The ratio of ESR/CRP was also utilized and found an AUC of 0.60. All of the AUC data are in the "fail to discriminate category." Although improvements in serology can be somewhat reassuring, there are no statistically significant values of ESR or CRP that would predict failure of reimplantation in the 2-stage treatment of PJI. Because we are flying blind consideration should be made for mandatory pre-reimplantation aspirates. Level IV, Retrospective Case Series.

Clinical and Laboratory Diagnostic Features of Kyasanur Forest Disease: A Study From Wayanad, South India

BackgroundKyasanur forest disease (KFD), also known as monkey fever, was first recognized in the Shimoga district of Karnataka, India, in 1957. This study was conceived to address the paucity of medical literature on KFD, to describe the clinical and laboratory features of real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) confirmed cases of KFD, and to detect any change in the clinical picture and presentation of the disease over the last 30 years.AimThe study sought to document the clinical and laboratory features of Kyasanur forest disease (KFD), a tick-borne arboviral disease, now emerging in many parts of southern India.Material and methodsThis was a retrospective study using secondary data of patients with real-time reverse transcription-polymerase chain reaction (rRT-PCR)-confirmed KFD in a secondary care hospital in Wayanad, Kerala, India.ResultsSixty rRT-PCR-proven KFD patients were included in the study. Commonly noted clinical symptoms were fever (98%), headache (80%), body ache (86%), vomiting (61%), and prostration (83%). Relative bradycardia, hypotension (45%), and oral lesions (23%) were the frequent physical signs. The median total leukocyte count and median platelet count at admission were 2600 per μL and 1.62 per μL, respectively. The median erythrocyte sedimentation rate was 10 mm/hr. Urinary sediments and albuminuria were seen in 66% and 60% respectively. The major complications observed were neurological complications (23%), bleeding manifestations (20%), and persistent shock (20%). The common neurological complications were seizures, altered sensorium, aseptic meningitis, and focal neurological deficits. The case fatality rate in the study was 6.7%.ConclusionsThe clinical picture of a prostrating viral syndrome in an epidemiological setting of KFD with marked leucopenia, moderate thrombocytopenia, low erythrocyte sedimentation rate (ESR), albuminuria, urinary sediments, and moderately elevated transaminases help in making an early diagnosis of KFD. Neurological complications in the initial two weeks are associated with poor outcomes.

P018 Functional impairment in enthesitis related arthritis patients

Abstract Background Enthesitis related arthritis (ERA) is a subgroup of juvenile idiopathic arthritis. It is characterized by the presence of enthesitis and predominately lower limb arthritis and can affect sacroiliac joint and spine. Recent studies showed that ERA is associated with worse physical status and poorer quality of life (1). The main objective of this study was to compare the aspects of functional status in patients (ERA) and patients with spondyloarthritis (SpA). Methods A retrospective monocentric study was carried out on patients with ERA (ILAR criteria) or SpA (ASAS Criteria). Demographic data and clinical characteristics were obtained from medical records. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein rate (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional impairment was evaluated by Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of life Questionnaire (ASQoL). Global well-being was assessed by Bath Ankylosing Spondylitis Global Index (BASGI). Population was divided into two groups: group 1 (G1) stands for ERA patients and group 2 (G2) stands for SpA patients. P &amp;lt; 0.05 was considered statistically significant. Results A total of 174 patients (40 ERA and 134 SpA) were enrolled. Mean age at disease onset was 12.4 ± 3 years in G1 and 27.8 ± 8 years in G2. Male to female sex ratio was 5.6 in G1 and 3.7 in G2. Morning stiffness (&amp;gt;60 min) was reported by 37.5% of G1 and 49.3%. G1 patients had longer morning stiffness than G2 (61 [0–90] min vs 30 [0–240] min; P = 0.58). Multiple nocturnal awakenings were reported by 45% of G1 patients and 58.2% of G2 patients. Median BASDAI score was 4.9 [1–44] in G1 and 4.5 in G2 [0–10] (P = 0.48). Median BASGI score was 6 [1.5–9.5] in G1 and 6 [0–10] in G2 (P = 0.58). Median ESR was 35 mm/h [8–90] in G1 and 35 mm/h [2–125] in G2. Median CRP was 18.2 mg/l [1–70] in G1 and 13 mg/l [3–180] in G2. The assessment of functional status revealed that G1 patients had higher BASFI scores than G2 patients (5.2 vs 4.5). The association between G1 and BASFI was statistically significant (P = 0.05). Median ASQoL was 12 [2–17] in G1 and 9 [0–18] in G2. No link was noted between G1 and ASQoL score (P = 0.152). Conclusion Our study showed that ERA was associated with higher BASFI scores in comparison with SpA. Treat-to target strategies are mandatory in order to optimize the functional status of children with ERA.

P009 Osteoporosis is a frequent complication in enthesitis related arthritis patients

Abstract Background Enthesitis related arthritis (ERA) represents a clinical entity of juvenile idiopathic arthritis. This chronic rheumatic disease may lead to early bone mass loss and increase risk fracture. The aims of this study were to evaluate the prevalence of clinical osteoporosis in patients with ERA and to identify what factors are associated with increased occurrence of osteoporosis. Methods We reviewed the medical records of patients with confirmed ERA. We analyzed their demographic data and the clinical characteristics. Dual-energy X-ray absorptiometry (DEXA) was used to determine bone status. Osteoporosis was defined as Z score &amp;lt;-2.5DS. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Data were analyzed using the SPSS statistical package. A P-value &amp;lt; 0.05 was considered significant. Results Thirty-three patients (27 male and 7 female) with a mean age at of 23.8 ± 7.5 years were enrolled. The mean age at disease onset was 12 ± 2.6 years. Median disease duration was 108 months [12–408]. The median ESR and CRP levels were 35 mm/h [8–90] and 20 mg/l [1–70] respectively. Median BASDAI score was 4.7 [1–9.7]. At bone densitometry, osteoporosis and osteopenia were found in 44.1% and 23.5% cases respectively. None of the patients had a history of osteoporotic fractures. Long term corticosteroid therapy and sedentarily were noted in 18.2% and 47.1% of patients respectively. On statistical analysis, osteoporosis was associated with these parameters: age at ERA onset (P = 0.035), disease duration (P = 0.04), CRP (P = 0.009), BASDAI score (P = 0.05) and sedentarily (P = 0.031). Neither corticosteroid therapy (P = 0.68) nor high ESR level (P = 0.73) were associated with osteoporosis. Conclusion In this study, osteoporosis was a common extra articular feature during ERA. As adult spondyloarthritis, disease activity, duration and sedentarily seem to be associated with the bone loss.

P029 Assessment of diagnosis delay during enthesitis related arthritis

Abstract Background Enthesitis related arthritis (ERA) is a distinct subgroup of juvenile arthritis characterized by male predominance and adolescent onset. Though, ERA patients still experience long diagnosis delays. This may lead to articular damage and functional disability. The aim of this study was to quantify the lag time between ERA symptoms onset and diagnosis and to evaluate its impact on disease activity, functional disability and structural damage. Methods A retrospective monocentric study was carried out on ERA patients. Diagnosis delay was collected from patients’ medical files. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional disability and structural damage were evaluated by Bath Ankylosing Spondylitis Fonctional Index (BASFI) and Bath Ankylosing Spondylitis Radiology Index (BASRI) respectively. Data were analyzed using the SPSS statistical package. A p-value &amp;lt; 0.05 was considered significant. Results Thirty-four patients with a mean age of 23.8 ± 7.5 years were included. Male to female sex ratio was 3.85. Mean age at disease onset was 12 ± 2.6 years. Median disease duration was 108 months [12–408]. Median ERA diagnosis delay was 10 months [3–108]. Median ESR and CRP were 35 mm/h [8–90] and 20 mg/l [1–70] respectively. Median BASDAI score was 4.7 [1–9.7]. Median BASFI and BASRI scores were 4.6 [1.9–10] and 10 [2–16] respectively. Coxitis was found in 38.2% of cases. On statistical analysis, significant positive correlation was found between ERA diagnosis delay and ESR (P = 0.03, r = 0.69) and CRP (P = 0.05, r = 0.456) respectively. No link was noted between ERA diagnosis delay and these parameters: gender (P = 0.58), age at disease onset (P = 0.68), occurrence of coxitis (P = 0.66), BASFI (P = 0.08), BASDAI (P = 0.45) and BASRI (P = 0.12). Conclusion ERA patient’s journey was long in our study. Longer delays were associated with higher ESR and CRP levels. Further studies are required to confirm our results.

Evaluation of clinical findings and treatment options of Sydenham chorea patients

Background/Aim: Sydenham chorea is an autoimmune neurological disorder of the childhood which occurs due to cross-reaction of antibodies against group A beta-hemolytic streptococci in the basal ganglia. We evaluated patients with Sydenham’s chorea, treatment options, recovery duration, and relapses to determine whether there is any relationship between biochemical parameters such as erythrocyte sedimentation rate (ESR), serum Anti Streptolysin Antibody (ASA), and patients’ clinical course. Methods: This case series includes patients with Sydenham chorea who visited the pediatric neurology outpatient clinics between May 2013 and September 2018. Neurologic examination was performed by a pediatric neurologist, and electrocardiography and echocardiography were performed by a pediatric cardiologist. ESR and ASA levels, treatment options, and clinical course of the disease were evaluated. Results: Sixteen patients, with nine females (56.3%) and seven males (43.7%) were included in this study. The most seen chorea type was hemichorea. The median ASA and ESR values of the patients were 619 IU/ml (278.25-794.75) and 17.5 mm/h (7.25-27), respectively. Their median age and time until recurrence were 12 (9-14.25) years and 16 months (9-18), respectively. The median recovery period was 5.5 months (3-6). Diazepam and haloperidol were the most used secondary treatment options. Mitral insufficiency (MI) was the most frequent finding (56.3%). Benzathine penicillin and secondary prophylaxis, e.g., haloperidol, diazepam were our treatment agents of choice. ASA levels were lower among patients treated with steroids (U=9, z=-2.38, P=0.017). Age was moderately positively correlated with recovery period (age r (14) = 0.738, P=0.001)), while no correlation was found between age and ESR, or recurrence period (P=0.98, P=0.33, respectively). The recovery period of generalized chorea was longer than that of hemichorea (U=10.5, z=-1.96, P=0.05). Recurrence was not related to ASA levels, ESR levels, age, or recovery period (P=0.73, P=0.89, P=0.78, P=0.83 respectively). Conclusion: High ASA levels may not indicate steroid need, and the recovery period increases with age and in cases of generalized chorea. Instead of benzathine penicillin or other known secondary prophylactic agents, azithromycin and levetiracetam can be used in hypersensitive patients.

Evaluation of serum ferritin and its correlation with disease activity in non-systemic juvenile idiopathic arthritis

Background: Serum ferritin is considered as an acute phase reactant that often increases in presence of an active inflammation. Its status as a disease activity marker is well-established in systemic juvenile idiopathic arthritis (JIA), but underexplored in other categories. The objective of this study was to evaluate the relation of serum ferritin with disease activity in non-systemic categories of JIAMethods: A prospective analytical study was carried out involving 46 JIA patients (diagnosed and categorized on the basis of ILAR criteria) with high disease activity based on juvenile arthritis disease activity score27 (JADAS27). childhood health assessment questionnaire (CHAQ), erythrocyte sedimentation rate (ESR), serum ferritin, pain VAS (visual analog scale), parent global VAS, JADAS27 were measured at initial visit, six months and one year.Results: 40 (21 female, 19 male) out of 46 patients completed follow-up of 1 year. Amongst them, 11 patients had systemic arthritis, 10 had oligoarthritis, 11 had RF positive polyarthritis and 8 had RF negative polyarthritis. Their median ages at the initial visit were 7, 6.5, 8 and 7.5 years respectively. Serum ferritin, CRP, ESR, CHAQ score and JADAS decreased over time in all four categories of JIA. Median ESR, ferritin, CHAQ and JADAS27 were higher in systemic JIA compared to other groups in all three visits. Serum ferritin significantly correlated with JADAS27 at all three visits in systemic arthritis; at initial visit in oligoarthritis; at initial visit and 6 months in both RF positive and RF negative polyarthritis.Conclusions: In patients with systemic JIA, serum ferritin showed significant correlation throughout disease course even when the disease activity was low. But in non-systemic categories of JIA serum ferritin had a significant positive correlation with disease activity only when the disease activity was high.