Background: Cartilage damage in RA has been evaluated by joint space narrowing (JSN) in X-ray, while it is not a direct evaluation of cartilage. Previously we have confirmed the usefulness of the direct imaging of finger joint cartilage by ultrasound (US) in patients with RA [1]. Objectives: We aimed to examine the temporal changes of US cartilage thickness in RA patients. Methods: We enrolled 53 RA patients in whom the cartilage thickness of finger joints was measured by US and had radiographs of both hands at baseline and 1-year later. The cartilage of metacapophalangeal and proximal interphalangeal joints of 2nd to 5th fingers were bilaterally visualized at the middle portion from a longitudinal dorsal view. Cartilage thickness was measured from the base of the cartilage to the interface artefact at the cartilage surface by static images. In addition, the JSN of the corresponding joints was scored using a hand X-ray by van der Heijde-modified Sharp method. Continuous variables from the two groups were analyzed using the Mann-Whitney U test or Wilcoxon signed-rank test. The relationships among the continuous variables were assessed using the Spearman’s rank correlation coefficient. Results: The median age of the patients was 68 years and the median disease duration was 6.3 years. The sum of total cartilage thickness from 16 joints per patient ranged from 3.1 to 9.1mm (median 6.5 mm) at baseline, and it was significantly correlated with total JSN score of the same joints (ρ=-0.63, p<0.001). The cartilage thickness was inversely correlated with disease duration (rho=-0.40, p=0.003), but not associated with age nor height. The decrease in cartilage thickness over 1 year was evident in patients with persistent moderate to high disease activity by the DAS28-CRP (n=10; median -6.2%) as compared with other patients (n=43; median -1.2%, p=0.004 versus active patients). Conclusion: This pilot study demonstrated the progression of cartilage damage by sustained RA activity, supporting the validity and usefulness of joint cartilage thickness evaluation by ultrasound in patients with RA. References: [1]Ogura T, et al. Arthritis Care Res 2019 Oct 25. Table 1. SALIENT FEATURES OF THE 9 PATIENTS PRESENTING WITH RETINAL TOXICITY DUE TO HCQ Sl.No Age Gender Weight (Kg) Primary Diagnosis Dose Duration (Years) Detection Method Used Recommended Dose (mg/Day) Received Dose (mg/Day) Cumulative Dose (grams) FUNDUS EXAM. SD-OCT HVF 10-2 F AF 1 47 F 58 SLE 290 400 438 3 RPE Changes Thinning/Photoreceptor Loss Defects seen - 2 20 F 46 SLE 230 200 146 2 Multiple Small Drusens In Paramacular Area Multiple Drusens Normal Perifoveal autofluorescence spots- drusens 3 23 F 50 SLE 250 400 146 1 RPE Changes RPE Disruptions Defects seen - 4 30 F 55 SLE 275 200 73 1 Normal Normal Paracentral Scotoma - 5 50 F 49 RA 245 200 511 7 Early Bull’s Eye Maculopathy RPE Atrophy Defects seen - 6 72 F 60 RA 300 200 730 10 RPE Atrophy FR Absent RPE Atrophy General reduction in sensitivity - 7 65 M 57.4 RA 287 200 146 2 RPE Changes RPE Disruptions & Thinning Noted Defects seen - 8 62 F 70 RA 350 200 219 3 Chorioretinal Atrophy Altered RPE Membrane Defects seen - 9 59 M 71.6 RA 358 200 292 4 RPE Changes RPE Disruptions Normal - F:Female; M:Male; SLE:Systemic Lupus Erythematosus; RA: Rheumatoid Arthritis, FUNDUS EXAM.: Fundus Examination; SD-OCT:Spectral Domain-Optical Coherence Tomography, HVF 10-2:Humphrey Visual Field 10-2; FAF: Fundus Autofluorescence, RPE:Retinal Pigment Epithelium; FR:Foveal Reflex Disclosure of Interests: None declared
Objective Joint destruction in rheumatoid arthritis (RA) includes both bone and cartilage lesions. Since joint space narrowing (JSN) is not a direct evaluation of cartilage using radiography, we aimed to examine the validity of ultrasound (US) cartilage evaluation using a semiquantitative method in patients with RA. Methods We enrolled 103 patients with RA who were in remission or showing low disease activity and 42 healthy subjects. The cartilage thickness of the bilateral metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the second to fifth fingers was measured by US, and the recorded images were scored semiquantitatively using a scale of 0–2. In addition, the JSN of the corresponding joints was scored using a hand radiograph. The relationships between total cartilage thickness, its semiquantitative score, and JSN score were assessed using Spearman’s rank correlation coefficients. Results Total cartilage thickness was significantly thinner in patients with RA compared to healthy subjects for both the MCP and PIP joints (both P < 0.001). The semiquantitative sum of 16 joints ranged from 2 to 26 (median 8) in patients with RA, which was significantly greater than the 0–11 (median 4) in healthy subjects ( P < 0.001). In patients with RA, the semiquantitative score showed a significant negative correlation with cartilage thickness (ρ = −0.64, P < 0.001) and a significant positive correlation with JSN score (ρ = 0.66, P < 0.001). Furthermore, these scores showed a significant correlation with RA disease duration. Conclusion A simplified and direct evaluation of finger joint cartilage damage by semiquantitative US score is valid and useful for patients with RA.
Joint destruction in rheumatoid arthritis (RA) includes both bone and cartilage lesions. Since joint space narrowing (JSN) is not a direct evaluation of cartilage using X-ray, we aimed to examine the validity of ultrasound (US) cartilage evaluation in patients with RA.
Objectives:
Methods:
The cartilage thickness of bilateral metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the 2nd to 5th fingers were visualized from a dorsal view with joints in approximately 90 degrees flexion and measured at the middle portion. Furthermore, one US examiner performed the semiquantitative scoring of the recorded cartilage images in a blinded manner on a scale of 0–2. In addition, the JSN of the corresponding joints was scored using the van der Heijde-modified Sharp method with a hand X-ray. Continuous variables were analysed using the Mann–Whitney U test. The relationships among the total measurement of cartilage thickness, its semi-quantitative score, and the JSN score were assessed using Spearman's rank correlation coefficients.
Results:
One hundred and three patients with RA and 42 healthy subjects were enrolled in this study. The total cartilage thickness was significantly thinner in patients with RA compared to healthy subjects for both the MCP and PIP joints (both p<0.001). The semi-quantitative sum of 16 joints ranged from 2 to 26 (median 8) in patients with RA, which was significantly greater than the 0 to 11 (median 4) seen in healthy subjects (p<0.001). In patients with RA, the semi-quantitative score showed a significant negative correlation with cartilage thickness (rho=−0.64; p<0.001) as well as a significant positive correlation with JSN score (rho=0.66; p<0.001). In addition, in healthy subjects, semi-quantitative score, but not cartilage thickness was significantly correlated with age (rho=0.49; p=0.001 and rho=–0.25; p=0.118, respectively). On the other hand, in RA, these scores showed a significant correlation with RA disease duration but not correlated with age.
Conclusion:
A simplified and direct evaluation of finger joint cartilage damage by semi-quantitative US score is valid and useful for patients with RA.
The current "treat-to-target (T2T)" strategic concept has been applied to systemic lupus erythematosus (SLE), stating "lupus maintenance treatment should aim for the lowest glucocorticoid (GC) dosage, and if possible, GCs should be withdrawn completely". We have already reported the successful trade-off between GCs and immunosuppressive agents (ISA) in the prevention of SLE flare.
Objectives:
We aimed at the retrospective evaluation of current SLE treatment status by focusing on the maintenance dose of GCs and the use of ISA as well as the rate of GC-free patients.
Methods:
We enrolled 121 patients with SLE patients who was visiting our medical center.All the patients met the American College of Rheumatology (ACR) 1997 or 2012 revised criteria for SLE classification and were followed-up for ≥ 6 months after diagnosis. We evaluated patient backgrounds, SLE disease activity index (SLEDAI) score, the dose of GC, and the use of ISA or biologics from the medical records.
Results:
Currently, 94% of patients achieved GC dosage of 5 mg/day (prednisolone equivalent) or less and the median GC dosage was 2 mg/day. In addition, 48 (40%) patients were successfully managed with hydroxychloroquine (HCQ) and/or ISA only (including never- and ex-users of GCs). The users of HCQ, ISA, and biologics were 63%, 68% and 7%. respectively. Among ISA, mycophenolate mofetil (38%) and tacrolimus (35%) were commonly used, including their combined use (16%). GC-free patients achieved the median SLEDAI of 1 despite the median SLEDAI of 10 at the first presentation and the median disease duration of 10.5 years, which were comparable with the remaining patients.
Conclusion:
The T2T strategy for GC dose is applicable for almost all the patients with SLE, and GC-free management is becoming a realistic treatment goal with the aggressive use of HCQ, ISA, and biologics.
We evaluated the influence of operative procedure on arterial ketone body ratio (AKBR), which indicates the function of the liver cells, in patients undergoing gastrectomy or mastectomy. AKBR during the stomach resection was significantly lower than that during the breast resection. A significant reduction in AKBR due to induced hypotension was observed in mastectomy group. SGOT and SGPT increased significantly in gastrectomy group, but unchanged in mastectomy group on the first and the seventh postoperative days. On the first post-operative day, SGOT and SGPT in gastrectomy group were significantly higher than those in mastectomy group. These findings suggest that influence of operative procedure on the liver during gastrectomy is more serious than that during mastectomy.
Objective This study examined whether or not the disease control in Japanese patients with systemic lupus erythematosus (SLE) had improved in recent years and its possible association with altered balance between the use of glucocorticoids and immunosuppressants.
Abstract To elucidate the disease-flare process in rheumatoid arthritis (RA) after discontinuing biological disease-modifying antirheumatic drugs (bDMARDs), we first focused on RA-flare prediction after achieving stringent remission criteria. Patients with RA who maintained a simplified disease activity index ≤ 3.3 for ≥ 3 months during November 2014–January 2018 in our medical centre in Tokyo, Japan, were eligible. The primary endpoint was flare (disease activity score 28—erythrocyte sedimentation rate ≥ 3.2 with increase from baseline > 0.6) within 2 years after bDMARD discontinuation. Comprehensive clinical assessments, ultrasonographic evaluation of 40 joints, and blood sampling for 12 biomarkers were performed every 2–3 months for 2 years unless patients experienced flare. Flare-positive and flare-negative patients were compared using univariate and Kaplan–Meier analyses. Thirty-six patients (80.6% female, median disease duration, 5.2 years; median treatment period with discontinued bDMARD, 2 years; median remission duration, 18 months) were enrolled. Twenty patients (55.6%) experienced RA flare 43–651 (median, 115) days after the first skipped date of bDMARDs. Two patients who withdrew without disease flare were excluded from the comparison. Clinical and ultrasonographic evaluations did not show significant between-group differences; Kaplan–Meier analysis showed that higher baseline soluble tumour necrosis factor receptor 1 (sTNFR1) concentration impacted subsequent disease flare (p = 0.0041); higher baseline interleukin (IL)-2 concentration was exclusively beneficial to patients with lower sTNFR1 (p = 0.0058), resulting in remission maintenance in 83.3% of patients with lower sTNFR1 and higher IL-2. We demonstrated the usefulness of combined biomarker evaluation for predicting sustained remission after bDMARD discontinuation in RA.
Background: Cartilage damage in rheumatoid arthritis (RA) has been evaluated by joint space narrowing (JSN) in X-ray, despite the fact that it is not a direct evaluation of cartilage. We have recently reported that direct evaluation of finger joint cartilage thickness evaluated by ultrasound (US) is valid and useful for patients with RA 1) . Objectives: In this study, we aimed to examine the progression of cartilage damage in RA patients. Methods: Forty-six patients with RA who had completed the US evaluation of finger joint cartilage thickness at baseline and after 1 year were included in this study. The cartilage thickness of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of 2nd to 5th fingers were bilaterally visualized and measured at the middle portion of MCP and PIP joints from a longitudinal dorsal view, with approximately 90 degrees flexion. Cartilage thickness was measured from the base of the cartilage to the interface artefact at the cartilage surface by calculating the pixel counts on DICOM images. Results: In patients, 78% were female, the median age was 68 years and the median disease duration of the patients was 6 years. The median DAS28-CRP at baseline was 2.6. The sum of total cartilage thickness from 16 joints per patient ranged from 3.1 to 9.1 mm (median 6.4 mm) at baseline, and it was significantly correlated with disease duration (ρ=-0.423, p=0.003). A significant decrease from the baseline in the cartilage thickness (median -1.6%) was observed after 1 year (p=0.041). Furthermore, patients with persistently moderate/high disease activity for 1 year by DAS28-CRP (n=9) showed a greater decrease in the cartilage thickness than the remaining patients with controlled disease activity (n=37) (median -5.9% versus -1.5%, respectively, p=0.029). Conclusion: This study further supported the validity and usefulness of joint cartilage thickness evaluation by US in patients with RA. References: [1]Ogura T, et al. Arthritis Care Res 2019 Oct 25. Disclosure of Interests: Takehisa Ogura: None declared, Ayako Hirata: None declared, Sayaka Takenaka: None declared, Yuki Inoue: None declared, Takaharu Kagtagiri: None declared, Yuto Takakura: None declared, Hideki Ito: None declared, Hideto Kameda Grant/research support from: Abbvie, Asahi-Kasei, Chugai, Eisai, Mitsubishi-Tanabe and Novartis, Consultant of: Abbvie, Boehringer, Celgene, Eli Lilly, Janssen, Novartis, Sanofi, UCB, Speakers bureau: Abbvie, Asahi-Kasei, BMS, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Novartis and Pfizer
We examined the changes in the electromagnetically measured left lower lobe blood flow (QLLL) when the left lower lobe (LLL) was exposed to alveolar hypoxia selectively under two different positions (supine and right lateral position in 18 dogs. QLLL/CO, Qs/Qt and other cardiopulmonary parameters were obtained during the following experimental sequence; 1) the whole lung ventilated with 100% O2 (control), 2) LLL collapsed and the remainder ventilated with 100% O2, 3) N2 expansion of LLL (N2 CPAP) and the remainder ventilated with 100% O2, 4) O2 expansion of LLL (O2 CPAP) and the remainder ventilated with 100% O2, and 5) The whole lung ventilated with 100% O2. In the supine position group (n = 9), both selective collapse and N2 CPAP of LLL caused QLLL/CO to decrease significantly (P less than 0.02) from control values (14.9 +/- 1.7%) to 10.6 +/- 0.9% and 11.9 +/- 1.6%, respectively. But there was no difference in QLLL/CO between collapse and N2 CPAP of LLL. In the right lateral position group (n = 9), hypoxic exposure of LLL caused no decrease in QLLL/CO from control values. But QLLL/CO during N2 CPAP (8.5 +/- 1.1%) decreased significantly than that during collapse (10.8 +/- 1.5%) (P less than 0.02). Qs/Qt during N2 CPAP (15.6 +/- 1.4%) also decreased significantly (P less than 0.05) from that during collapse (18.5 +/- 2.2%). We conclude that the difference of the changes in QLLL/CO under hypoxic exposure between supine and right lateral position was caused by hydrostatic pressure which influenced more during lateral position than during supine position.
Objective We evaluated the performance of the revised classification criteria for assessing different systemic autoimmune rheumatic diseases and their overlap syndromes. Methods A total of 652 patients with or highly suspected of having systemic lupus erythematosus (SLE), systemic sclerosis (SSc), polymyositis (PM)/dermatomyositis (DM) or rheumatoid arthritis (RA) were included in this study. The 1997 revised American College of Rheumatology (ACR) and the 2019 European League Against Rheumatism (EULAR)/ACR criteria for SLE, the 1980 ACR and the 2013 ACR/EULAR criteria for SSc, the criteria by Bohan and Peter and the 2017 EULAR/ACR criteria for PM/DM, and the 1987 revised ACR and 2011 ACR/EULAR criteria for RA were used for disease classification. Results The old and new criteria and a clinical diagnosis were used to respectively classify 103, 106 and 105 SLE patients; 35, 47 and 58 SSc patients; 18, 23 and 33 PM/DM patients; and 297, 389 and 468 RA patients. Sensitivity increased from 82.9% to 92.4% in SLE, from 56.9% to 79.3% in SSc, from 54.5% to 66.7% in PM/DM, and from 62.6% to 80.8% in RA. SLE-SSc was the predominant type of clinical overlap syndrome, while SLE-RA was the most classifiable. Conclusion The revised classification criteria for all the diseases showed an improved sensitivity, and SLE-overlap syndrome was predominant, regardless of the criteria sets.
