Severity Of Radiological Changes Research Articles

Radiological measurements of the feet of normal Straight Egyptian Arabian horses in Qatar

The Arabian horse has been identified as carrying a risk locus for equine metabolic syndrome, predisposing this breed to development of laminitis. Radigraphy of the equine foot is widely considered the main diagnostic imaging technique for evaluation of the laminitic horse. Knowledge of ‘normal’ breed values allows assessment of the degree and severity of radiological changes associated with laminitis. The objective of this study was to investigate the normal values for radiological measurements of the feet of the Straight Egyptian Arabian horse in Qatar. The design was a clinical prospective study. Radiographs of the fore and hind feet of 10 clinically normal adult Straight Egyptian Arabian horses were taken. On the lateromedial views, 17 measurements were taken (13 distances and four angles). On the horizontal dorsopalmar/plantar views, two measurements were taken. On the dorsal 45 degree, proximo-palmarodistal oblique projections, four measurements were taken. Normal reference ranges were reported for radiological measurements of the feet of the Straight Egyptian Arabian horse. Several variables showed significant differences between fore and hind feet, including hoof angle, distal wall thickness, and two proximal inner layer measurements (p < 0.05). In addition, the Straight Egyptian Arabian horse was found to have a number of measurements which varied from previously published reports. The results reported within provide a useful reference for normal radiographic measurements of the Straight Egyptian Arabian horse with relevance for laminitis.

Analysis of adherence to treatment in patients with rheumatoid arthritis

Patients' adherence to drug therapy, medical support and implementation of the doctor's recommendations for lifestyle changes can affect the effectiveness of therapy and quality of life in patients with rheumatoid arthritis (RA).Objective: to analyze adherence to treatment, medical support and implementation of recommendations for changing the lifestyle in RA patients, including those with and without low-energy bone fractures.Patients and methods. The study included 88 women with a definite diagnosis of RA. All patients were followed up for a long time (on average 8.45±1.34 years) at V.A. Nasonova Research Institute of Rheumatology. All patients underwent clinical, radiological and laboratory examinations, and a questionnaire for the quantitative assessment of adherence to treatment was completed.Results and discussion. The integral indicator of adherence to treatment in 30 (34%) patients corresponded to a low level, in 51 (58%) – to an average level, and in 7 (8%) – to a high level. Low adherence to medical support was more often determined in patients with anxiety (p=0.02) and depression (p=0.04). The intake of oral glucocorticoids (GC) was associated with a high adherence to drug therapy (p=0.01). Adherence rates in the group of RA patients with and without bone fractures did not differ significantly. Functional disorders and the severity of radiological changes also did not differ significantly in patients with different levels of adherence.Conclusion. Patients with RA had predominantly an average level of adherence to drug therapy, medical support, and a low level of adherence to recommendations for lifestyle changes. Oral GC were associated with high adherence to drug therapy, while low adherence to medical support was associated with anxiety and depression. Treatment adherence rates in the group of RA patients with and without bone fractures did not differ.

Radiological changes in shoulder osteoarthritis and pain sensation correlate with patients’ age

PurposeOsteoarthritis (OA) is one of the most common musculoskeletal disorders in the aging population. The correlation of radiographic OA severity, disability and pain is variable and inconsistent for the different joints. This study aims to elucidate the relationship between histological and radiological signs of shoulder OA with pain sensation and functional impairment to potentially adapt the recommendation for surgical treatment for primary total shoulder arthroplasty (TSA).MethodsForty-four patients with shoulder OA undergoing TSA using an anatomic stemless implant were included in this study. The radiological OA severity was scored pre-operatively on true ap X-rays according to the Kellgren–Lawrence score (KL-Score). Acromial types according to Bigliani were defined by pre-operative radiological images. The histological OA severity was determined according to the OARSI-Score using bone–cartilage sections from loaded areas of the humeral head. Pain was quantified using the visual analog scale (VAS). The functional status was assessed by the items “mobility” and “strength” out of the Constant–Murley score (CS Score). Demographic data including BMI, age, gender, diabetes mellitus and smoking were recorded.ResultsThere was no correlation between radiographic and histological severity in shoulder OA. However, a correlation of age and the severity of radiological changes was observed. Further, pain did not correlate with histological or radiological scores, whereas it correlated with age and the presence of diabetes mellitus. The functional shoulder status (mobility, strength) correlated with the severity of radiological changes, but not with the histologic scoring, which correlated with nicotine abuse.ConclusionThis study shows that increased age is the main determinant of radiological changes in shoulder OA, as well as pain. Therefore, age and pain sensation should be considered as important parameters for the recommendation for TSA.

Нейропатический компонент боли у больных остеоартритом

Background: chronic joint pain in osteoarthritis (OA) is an important factor of maladaptation. According to modern concepts, there are two variants presented in this pathology: nociceptive and nociplastic. Much less is known about the contribution of the neuropathic component (NC) to the pain syndrome formation. Aim: to study the pain syndrome patterns in patients with OA, as well as to identify NC in such patients and its impact on the life quality. Patients and Methods: the prospective study included 31 patients (mean age — 62.9±6.7 years, 26 (83.9%) women) with stage I–III OA of the knee and/or hip joint. The course of the articular syndrome corresponded to the pain syndrome course and ranged from 2 months to 30 years, averaging 10.6±9.9 years. All patients underwent general clinical examination. To detect neuropathic pain component (NPC), a neurological examination was performed using the DN4 and painDETECT questionnaires. The level of life quality was determined by the EQ-5D questionnaire. Results: NPC was detected in almost half (48%) of the examined patients. At the same time, the severity of radiological changes in the joints did not depend on its presence. However, in the presence of NC, the following manifestations were significantly more common in the area of the most affected joint (p&lt;0.05): burning, numbness, electric shock, hypoesthesia, tingling, a feeling of crawling and/or tingling. There was practically no such symptom as itching, while the frequency of hypoesthesia in the groups did not significantly differ. According to the EQ-5D questionnaire, lower indicators were observed in patients with the NPC, their mobility assessment and daily activity were significantly worse. Mixed anxiety–depressive disorder were also observed (p&lt;0.05) in such patients. Conclusion: for adequate treatment of pain syndrome, it is necessary to determine the presence of NPC in patients with OA and use antidepressants and anticonvulsants in complex therapy. KEYWORDS: osteoarthritis, chronic pain syndrome, nociceptive pain, nociplastic pain, neuropathic pain component, life quality. FOR CITATION: Filimonova O.G. Neuropathic pain component in patients with osteoarthritis. Russian Medical Inquiry. 2022;6(3):113–119 (in Russ.). DOI: 10.32364/2587-6821-2022-6-3-113-119.

Foot static disturbances and clinical features in overweight patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic, inflammatory, connective tissue disease, leading to foot deformities, impairment of locomotive functions, and reducing patients' quality of life. Obesity prevalence is rising in early RA and is associated with worse disease activity, function and health-related quality of life, with a significant negative impact on achieving a low Disease Activity Score in 28 joints (DAS28). The aim of the study was to evaluate foot deformities in overweight RA patients according to the severity of the disease. The study was performed on 50 overweight women with RA. The control group consisted of 50 overweight women free of any disorders. Plantography examination was carried out by means of a CQ ST 2K podoscope. Rheumatoid arthritis disease activity was assessed by DAS28. Activity limitation was assessed using the Health Assessment Questionnaire (HAQ) and foot posture by the Foot Posture Index (FPI-6). Body composition analysis was performed using In Body 220. Hallux valgus was the most frequent deformation in RA patients with overweight. Longitudinal flat foot was much more frequent in RA patients than transverse flat foot. A relationship between fat tissue mass and presence of transverse flat foot in RA patients with overweight was found. In this group DAS28, VAS, and Clarke's angle were correlated with increased value of HAQ. Plantar contourography showed a trend of an increase of α angle values and the Sztriter-Godunow index (KY) in overweight RA patients with increasing severity of radiological changes and DAS28, requiring use of proper prevention and therapeutic strategies of destructive changes.

Combined anomalies of axial skeleton

Detection of the combined anomalies of the axial skeleton, including anomalies of the craniovertebral junction, cervical spine and ribs, is rare, and the differential diagnosis of such anomalies is a difficult task. Clinical cases of combined congenital malformations of the craniovertebral junction, cervical spine and ribs are described. Two clinical cases confirm the appearance of the first complaints and neurological syndromes in patients with combined anomalies of the axial skeleton at the age of 20-40 years after minor traumatic injuries. In the third case, there is no correspondence between the severity of radiological changes and clinical manifestations, when radiological findings were regarded as accidental.

Transient sacroiliac joint-related pain is a common problem following lumbar decompressive surgery without instrumentation

ObjectivePatients with lumbar stenosis profit substantially from decompressive surgery. The change of body position and walking behaviour after successful surgery might lead to changed force effects on the entire spine and on the sacroiliac joint (SIJ). We analyzed the incidence of postoperative SIJ-related pain. MethodsThe authors analyzed the records of 100 consecutive patients from three institutions, who underwent decompressive surgery without instrumentation. The diagnosis of SIJ-related pain was confirmed by periarticular infiltration. The radiological changes of the sacroiliac joint were assessed in plain radiographs in both groups: patients with SIJ pain (group 1) and patients without SIJ pain (group 2) after surgery. Results22 patients required medical attention due to SIJ-related pain after surgery. While the walking distance increased substantially in both groups without difference (p=0.150), the analysis of overall satisfaction favoured group 2 (p=0.047). Female patients suffered more from SIJ pain after surgery (p=0.036). Age, severity of radiological changes or number of operated segments appeared not to trigger SIJ-related pain. ConclusionThe adaptation of a changed body posture and gait could lead to transient overload of the SIJ and surrounding myofascial structures. The patients should be informed about this possible condition to avoid uncertainty, discontent, unnecessary diagnostics and to induce a quick, specific treatment. Non-diagnosed sacroiliac joint-related pain could be a possible, but reversible reason for the diagnosis of a “failed-back-surgery”.

The relationship of clinical and laboratory measurements to two different radiological scoring methods in ankylosing spondylitis

Two different methods for scoring the severity of radiological changes in 19 patients with ankylosing spondylitis, using plain X-rays of the lumbar spine and sacroiliac (SI) joints, were assessed in relation to clinical and laboratory measurements. Bath Ankylosing Spondylitis Radiology Index (BASRI) and Stoke Ankylosing Spondylitis Spine Score (SASSS) were used to evaluate radiologic changes. Disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). There was no correlation between duration of morning stiffness, night pain, laboratory variables (ESR, CRP, hemoglobin, platelets) and any of the radiological scores. No significant correlation was found between BASDAI and both of the radiological scores. BASRI and SASSS correlated significantly with occiput-to-wall distance, Schober test, and finger-to-fibula distance. There was no significant correlation of radiologic scores with finger-to-floor distance and chest expansion. Right and left SI joint scores correlated significantly with BASRI and SASSS. The good correlation between spinal indexes and lack of correlation between clinical indicators of disease activity supports the notion that these two radiological scoring methods are measures of disease severity or deformity rather than disease activity. Radiological scoring methods are fundamental for the diagnosis and progression in AS and BASRI may be a more practical and appropriate method.

A prognostic index for erosive changes in the hands, feet, and cervical spines in early rheumatoid arthritis.

Clinical and laboratory measurements taken at the onset of rheumatoid arthritis in 149 patients were compared with the severity of radiological changes seen at 3 years in the hands and feet, and cervical spine. The strongest association with the severity of peripheral radiological damage was rheumatoid factor (p less than 0.0001 for both the latex titre and RAHA titre). Subluxation of the cervical spine was associated only with the presence of HLA-Dw2 (p less than 0.02) and HLA-B7 cross-reacting group (p less than 0.02). Discriminant function analysis utilizing latex titre, RAHA titre, haemoglobin level, and platelet count predicted the development of erosive or nonerosive disease in 79%. This method was less successful in predicting the actual severity of erosive damage and was not improved by the addition of HLA data. Radiological outcome in the cervical spine was successfully predicted in 82% using HLA-Dw2, HLA-B27 and age of onset of disease. It is concluded that the best predictors of erosive disease were standard laboratory features measured at onset, but that more powerful discriminant factors are needed if these are to influence clinical practice. Further prospective studies will establish whether rheumatoid involvement of the cervical spine is an expression of the influence of HLA determinants in this disease.

Clinical and Radiological Diagnosis of Crohn's Disease in Children

SummaryDiagnosis of Crohn's disease in children may be delayed because of obscure presention and inappropriate investigation. The clinical and radiological features in 35 children with Crohn's disease were reviewed retrospectively. The distal ileum and proximal colon were the most common sites of disease. Intestinal symptoms and signs were often overshadowed by nonspecific complaints. Proximal small bowel disease was characterised by oedema, clubbing, anaemia, and stunting of growth. The delay in diagnosis was less than in other series, although most prolonged in the group with proximal disease. We have identified a group of clinical features that strongly suggests Crohn's disease. In these patients, we believe a small bowel enema is justified. Small bowel enema, although invasive, is more effective than barium meal and follow‐through for demonstrating Crohn's disease. Severity of radiological changes did not correlate with clinical assessment. Neither bowel stricture nor fistula was found. Radiology of the colon was insensitive and colonoscopy is better for assessing colonic disease.

Clinical and radiological diagnosis of Crohn's disease in children.

Diagnosis of Crohn's disease in children may be delayed because of obscure presentation and inappropriate investigation. The clinical and radiological features in 35 children with Crohn's disease were reviewed retrospectively. The distal ileum and proximal colon were the most common sites of disease. Intestinal symptoms and signs were often overshadowed by nonspecific complaints. Proximal small bowel disease was characterised by oedema, clubbing, anaemia, and stunting of growth. The delay in diagnosis was less than in other series, although most prolonged in the group with proximal disease. We have identified a group of clinical features that strongly suggests Crohn's disease. In these patients, we believe a small bowel enema is justified. Small bowel enema, although invasive, is more effective than barium meal and follow-through for demonstrating Crohn's disease. Severity of radiological changes did not correlate with clinical assessment. Neither bowel stricture nor fistula was found. Radiology of the colon was insensitive and colonoscopy is better for assessing colonic disease.

Recurrent pyogenic cholangitis: A study by endoscopic retrograde cholangiography

Endoscopic retrograde cholangiograms were studied in 52 patients with recurrent pyogenic cholangitis, a condition which is prevalent in Asia and in which there is a primary bacterial cholangitis. The earlier changes of recurrent pyogenic cholangitis were identified and found to be confined to the intrahepatic biliary tree. The left hepatic duct was more severely affected than the right hepatic duct and had a higher infestation by clonorchis. The severity of radiological changes correlated well with the duration of illness and the need for surgery. Gallstones were present in 34.2% of the patients and pancreatic ductal abnormality in 7.7%. The decision for surgery could be made early and accurately, and the type of surgery and the assignment of surgeons could be planned in advance—situations which conventional intravenous cholangiograms could not achieve. Cholangitis complicated endoscopic retrograde cholangiograms in 23.1% of the initial 26 patients without antibiotic cover but none of the subsequent 26 in whom this was used.