UEMS Rheum atology Section – its role in Education and Training

Societal change and rise in demand for healthcare call for new health professional practices and task redistribution. Through negotiated order theory, this study explores how hospital rheumatologists (RT) and occupational therapists (OT) negotiate professional tasks in the clinical management of hand osteoarthritis. Fourteen qualitative interviews and 16 observations in clinical consultations were conducted in two hospitals specialized in rheumatology in Norway. Participants included eight OTs, six RTs, and patients in consultations. Data were analyzed using reflexive thematic analysis. Three themes were developed from codes: hierarchical ordering of hospital work impacts interprofessional negotiations; diagnostic organization of tasks preserves RT authority; and evidence-based recommendations in rheumatology enhance OT responsibilities. Overall, RTs and OTs enact tasks in succession where higher-ranking RTs establish a diagnosis and decide the subsequent in-hospital trajectory entrenched in a medical knowledge system. When medicine does not hold evidence-based treatment alternatives for patients, OTs respond by providing therapeutic interventions that are legitimized through international recommendations in rheumatology when they equip patients with tools to cope with chronic illness. Negotiations over tasks do not take place from equal power positions when status and knowledge hierarchies frame professional practices. The enactment of tasks is concurrently highly influenced by the arena of the workplace, where the two professional groups both cross boundaries and work together in concert despite professional differences in order to meet patient interests and provide relevant healthcare.

Perspectives on Poetry in Rheumatology

Rheumatoid arthritis (RA) is a common chronic and systemic autoimmune disease. Early diagnosis and standard treatment are the keys to control the disease and improve the prognosis. A variety of autoantibodies such as rheumatoid factor and anti-citrullinated peptide/protein antibodies can be detected in serum of patients with rheumatoid arthritis, which are important for early diagnosis and differential diagnosis of RA, judgment of disease severity and prognosis evaluation. The standardization of autoantibody detection related to rheumatoid arthritis is very important for its clinical application. Under the organization of the Committee of the Autoantibodies Detection of Rheumatology and Immunology Physicians Committee of Chinese Medical Doctor Association, expert consensus on clinical application of rheumatoid arthritis related autoantibodies detection were established by a joint group of Chinese multi-disciplinary experts. The consensus aims to standardize the detection of RA associated autoantibodies, and to provide a reference for clinicians and laboratory technicians to use and interpret rheumatoid arthritis-related autoantibodies in daily practice.

POS1274 THERAPEUTIC MANAGEMENT OF RHEUMATOLOGISTS VERSUS OTORHINOLARYNGOLOGISTS OF CERVICOGENIC DIZZINESS

The patient journey in knee osteoarthritis-variations in diagnosis, patient characteristics, and treatment by physician specialty

Women’s past, present, tomorrow in rheumatology

The American College of Rheumatology does not recommend modified shoes to relieve pain in patients with knee osteoarthritis (OA) because outcome data

OBJECTIVE To study the differences between clinically amyopathic dermatomyositis (CADM) and typical dermatomyositis (DM) on clinical and immunological features. METHODS By collecting clinical data of 106 CADM patients and 158 DM patients from January 2010 to June 2019 in the department of Rheumatology and Immunology, Peking University People's Hospital, the clinical characteristics and immunological features in the two groups were compared, and the distribution characters and the clinical meanings of myositis autoantibodies were discussed in the two groups respectively. Myositis autoantibodies were measured by immunoblotting according to the manufacturers' instructions. RESULTS In the aspects of clinical manifestations, CADM presented more with onset of interstial lung diseases (ILD) compared with DM (20.7% vs. 7.6%, P=0.002), and CADM-ILD was more likely to be acute ILD (58.3% vs. 26%, P < 0.001), and there were no differences between CADM and DM in cutaneous manifestations, accompanied with connective tissue disease (CTD) and malignancy. In CADM, the positive rate of rheumatoid factors and antinuclear antibodies was lower in DM. The most common myositis specific autoantibodies (MSAs) in CADM were anti-MDA5 (36%), anti-PL-7 (11.2%) and anti-TIF-1γ (10.1%). The most common MSAs in DM were anti-Jo-1 (19.2%), anti-TIF-1γ (11.5%) and anti-MDA5 (11.5%). Anti-MDA5 was correlated with acute ILD and skin ulceration both in CADM and DM; in CADM, skin ulceration was not associated with the titer of anti-MDA5; while in DM, skin ulceration was associated with high titer of anti-MDA5. In DM, anti-TIF-1γ was correlated with heliotrope eruption, V/shawl neck sign, perionychia erythma and malignancy, and higher rate of malignancy was seen in all titers of the anti-TIF-1γ positive patients. In CADM, anti-TIF1-γ showed no correlation with clinical manifestations. The most common myositis associated autoantibody was anti-Ro-52 both in CADM and DM. In CADM, anti-Ro-52 was associated with Raynaud's phenomenon and chronic ILD, while in DM, anti-Ro-52 was associated with mechanic's hands, noninfectious fever and accompanied CTD. CONCLUSION Compared with DM, ILD is more likely to be acute in CADM. It is different between CADM and DM about the distribution of myositis autoantibodies and the clinical significance of the same myositis antibody, and the clinical significance of some myositis antibodies is related to titers.

At the beginning of coronavirus disease 2019 (COVID-19) children seemed to be less affected and with milder symptoms than adults. Afterward, however, a warning was released regarding the possible association between COVID-19 and Kawasaki disease (KD) or Kawasaki-like disease. Thereafter, labels of Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) in Europe and Multisystem Inflammatory Syndrome in Children (MIS-C) in the USA were coined to refer to this new disease entity. The reality is that PIMS-TS/MIS-C resembles certain KD complications such as toxic shock syndrome and macrophage activation syndrome than to classic KD. PIMS-TS/MIS-C and KD share the viral origin (however just supposed for KD) and consequent dysregulated innate immune system inflammatory reaction. PIMS-TS/MISC symptoms occur about 2-4 weeks after the onset of COVID-19 or having been exposed to somebody positive for COVID-19, rather than in the acute phase of the infection. Clinically PIMS-TS/MIS-C affects older children than KD and presents more often with gastrointestinal symptoms, shock, and multi-organ dysfunction. myocarditis is more common in PIMS-TS/MIS-C than coronary artery aneurysms formation seen in KD. There are also differences in laboratory tests and immunology responses in KD and PIMS-TS/MIS-C. Thus PIMS-TS/MIS-C seems to be a new and multifaceted entity, distinct from KD, notwithstanding some common features in both. The dysregulated innate immune system reaction is responsible for PIMS-TS/MIS-C onset and outcome. A multidisciplinary approach, involving paediatric intensivists, paediatric cardiologists, infectious disease specialists, immunologists, and rheumatologists, is needed for the treatment of these children.

Objective: Osteoporosis is the pathological reduction of bone mineral density (BMD) and the most represented metabolic skeletal disease among population. A reduction in bone mineralization levels is associated with an increased risk of frailty fractures and of healthcare costs. Although there are many evidences bridging rheumatological diseases (such Systemic Sclerosis, Lupus Erythematosus Systemics and Rheumatoid Arthritis) with bone loss, very scarce and contradictory papers evaluate bone health in primary Sjogren's syndrome (pSS). Aim of this retrospective study is to evaluate BMD in pSS and its relationship with inflammatory markers, Ro/SSA and La/SSB antibodies. Methods: Fifty-three postmenopausal pSS were matched with 93 controls and studied for BMD measured by Dual Energy X- ray absorptiometry (DXA). Anti-nuclear antibodies (ANA), anti-extractable nuclear antigens (ENA), Anti- Ro/SSA, and anti-La/SSB antibodies, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected too. Mean BMDs of each explored region was compared and osteoporosis’s (OP) prevalence was assessed. Pearson’s analysis and multivariate regression models were built to highlight variables interrelations. Results: BMD was lower in pSS compared to controls, both expressed as g/cm2 and T-score considering lumbar spine and femoral neck. OP prevalence was higher among pSS compared to controls. Weight acted as the best predictor of lumbar BMD in multivariate model. No difference on BMD status was found between pSS with antibodies positivity and altered inflammatory markers with subjects displaying normal sera levels of the abovementioned variables. Conclusions: pSS female patients in an early stage of disease have lower BMD compared to healthy controls. Anti- Ro/SSA and anti/La antibodies and inflammatory markers are not related with BMD.

© 2019, American College of Rheumatology This is the peer reviewed version of the following article: Step Rate and Worsening of Patellofemoral and Tibiofemoral Joint Osteoarthritis in Women and Men: The Multicenter Osteoarthritis Study, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1002/acr.23864. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Objective: To determine the association of self-selected walking step rate with worsening of cartilage damage in the patellofemoral (PF) joint and tibiofemoral (TF) joint compartments at a 2-year follow-up visit. Methods: The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self-selected step rate was measured using an instrumented GAITRite walkway (CIR Systems) at the 60-month visit. Cartilage damage was semiquantitatively graded on magnetic resonance images at the 60- and 84-month visits in the medial and lateral PF and TF compartments. Step rate was divided into quartiles, and logistic regression was used to determine the association of step rate with the risk of worsening cartilage damage in men and women separately. Analyses were adjusted for age, body mass index, and knee injury/surgery. Results: A total of 1,089 participants were included. Mean ± SD age was 66.9 ± 7.5 years, mean ± SD body mass index was 29.6 ± 4.7 kg/m2, and 62.3% of the participants were women. Women with the lowest step rate had increased risk of lateral PF (risk ratio [RR] 2.1 [95% confidence interval (95% CI) 1.1–3.8]) and TF (RR 1.8 [95% CI 1.1–2.9]) cartilage damage worsening 2 years later compared to those with the highest step rate. Men with the lowest step rate had increased risk of medial TF cartilage damage worsening 2 years later (RR 2.1 [95% CI 1.1–3.9]). Conclusion: Lower step rate was associated with increased risk of cartilage damage worsening in the lateral PF and TF compartments in women and worsening medial TF joint damage in men. Future research is necessary to understand the influence of step rate manipulation on joint biomechanics in women and men.

A PAN-POSITIVE, RAPIDLY PROGRESSIVE PULMONARY RENAL PUZZLER

Concepts and perceptions about the diagnosis and treatment of fibromyalgia in a group of Colombian rheumatologists

Nachruf der Deutschen Gesellschaft für Rheumatologie auf Prof. Dieter Felsenberg

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The way to the rheumatological specialist assistant-a look into the history

A 73-year-old patient was seen in our hospital for treatment of metastatic adenocarcinoma of the prostate (pT 1a N 0 M 1a R 0 , BRCA-2 gene mutation). Prostatectomy and regional radiotherapy were performed and goserelin, a luteinizing hormone-releasing hormone (LHRH) analog, had been started because of disease progression. Castration-resistant progressive disease developed, and enzalutamide was added. A decrease of the prostate-specific antigen (PSA) level was achieved. Before the start of enzalutamide, the patient developed bilateral pain and stiffness of both hands combined with thickening of the hands. The symptoms progressed rapidly to bilateral flexion and extension contractures. The patient became unable to tie his shoelaces and had to use adjusted cutlery to eat. Consultation of the rheumatologist, X-rays, ultrasound and palmar skin biopsy of the hands were performed. The clinical picture resembles descriptions of “palmar fasciitis and polyarthritis syndrome” (PFPAS), a rare paraneoplastic syndrome. Positive effects of immunosuppressive medication have been reported in some cases. In our patient, treatment with oral prednisone (30 mg daily) showed no effect, therefore treatment was switched to methylprednisone pulses and methotrexate. PFPAS is an uncommon paraneoplastic syndrome characterized by rapid onset of bilateral arthritis of the hands, fasciitis of the palms, progressive stiffness and contractures. The scarcity of knowledge about PFPAS makes it difficult to recognize it at an early stage. As a paraneoplastic syndrome, it has been linked to various malignancies. Thus far, PFPAS has been described in only two other cases of prostate cancer. J Med Cases. 2020;11(9):267-270 doi: https://doi.org/10.14740/jmc3522

Introduction Dermoid cysts are benign developmental tumors that arise from the inclusion of ectodermal and mesenchymal components within the neural groove during embryonic development. Infection is rare and can lead to profound neurologic sequelae that closely mimic orthopedic or rheumatologic pathology. Case Report A previously healthy 2 year old male presented with 4 month history of progressive pain and refusal to ambulate or bear weight in his lower extremities. His initial decline began with falls while walking or running, followed by unilateral lower extremity pain, then bilateral lower extremity pain, and eventually refusal to ambulate. He also had …

Background: Localized scleroderma is a rare musculoskeletal disease that can potentially severely affect a child’s growth and function. The early lesions often do not strike physicians as worrisome as they can appear as demarcated erythema or a bruise like lesion. Like other rheumatologic diseases, history is key in distinguishing these worrisome lesions from similar benign lesions. It is important to recognize the lesions early as they are not reversible when they have reached the fibrotic stage. A localized scleroderma lesion can also be a sign of a more wide-spread disease such as eosinophilic fasciitis. Eosinophilic fasciitis is a disease related to scleroderma …