Relevance of Grade 1 Gray‐Scale Ultrasound Findings in Wrists and Small Joints to the Assessment of Subclinical Synovitis in Rheumatoid Arthritis
M. WittFelix MuellerAxel NiggChristiane ReindlJan LeipeFabian ProftNicola SteinAriane HammitzschStefan MayerClaudia DechantHendrik Schulze‐KoopsMathias Grünke
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Objective To investigate the clinical relevance of grade 1 findings on gray‐scale ultrasound (GSUS) of the joints in patients with rheumatoid arthritis (RA). Methods We examined the wrists and small joints of 100 patients with early or established RA and 30 healthy controls, using GSUS and power Doppler ultrasound (PDUS). Independent clinical assessment of all joints for tenderness and swelling according to the European League Against Rheumatism examination technique was performed. Joints with grade 1 findings on GSUS were identified, and associations with swelling, pain, and findings on PDUS were assessed. Grade 1 findings on GSUS in patients with early RA were reassessed after 6 months of antirheumatic treatment. Results Grade 1 results represented the majority of all GSUS findings in patients with RA and were also frequently recorded in healthy controls. Grade 1 GSUS findings were not associated with tenderness, swelling, or positive results on PDUS. In comparison to joints with grade 2 and grade 3 findings on GSUS, joints with grade 1 findings were less likely to respond to treatment. Conclusion The present results indicate that grade 1 findings on GSUS have limited clinical relevance.Keywords:
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It is generally easy to diagnose and treat patients with thyroid diseases, though there has been considerable uncertainty over whether or not to treat patients with subclinical disease.An overview of clinical symptoms and complications related to subclinical thyroid disease is presented on the basis of relevant literature.Patients with subclinical hypothyreosis (elevated TSH level and normal free T4) may benefit from treatment with thyroxine in relation to well-being, serum lipid levels, and possibly also blood pressure. Patients with subclinical hyperthyreosis (suppressed TSH level and normal free T4) have an increased risk of developing atrial fibrillation and possibly also dementia.Subclinical thyroid disease is usually progressive. If a transient condition is ruled out, proper treatment should not be delayed.
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According to guidelines, clinical arthritis is mandatory for diagnosing RA. However, in the absence of clinical synovitis, imaging-detected subclinical synovitis is increasingly used instead and is considered as a starting point for DMARD therapy. To search for evidence we studied the natural course of arthralgia patients with subclinical synovitis from three longitudinal cohorts and determined the frequencies of non-progression to clinically apparent inflammatory arthritis (IA) (i.e. 'false positives').
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Objective To study the relationship between subclinical epileptiformdischarge and transitory cognitive impairment, Methods BM800 AEEG Was used to analyse subclinical epileptiformdischarge of 8 patients from August, 1998 to March, 2002. Results The results indicate that 8 patients suffered from subclinical epilep- tiformdischange are all accompanied with TCI. Conclusion The result is show that subclinical epileptifor- mdischarge is connected with TCI. It is necessary to inspecte by AEEG the patients who have difficulties to study but have not obvious symptoms, subclinical.
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Objective To analyze the variety and clinic signification of lipids in patients with subclinical hypothyr oidism. Methods The levels of TSH,FT3,FT4,TC,TG,LDL-C,HDL-C in 52 subclinical hypothyroidism patients,60 controls and 55clinical hypothyroidism patients were determined and compared. Results Compared with the control the levels of LDL-C,TSH in clinical hypothyroidism and subclinical hypothyroidism patiens were higher (P0.01); the levels of FT4,TC, TG in clinical hypothyroidism patients were higher (P0.01). The level of TC in subclinical hypothyroidism patiens and FT3 in clinical hypothyroidism patients was higher (P0.05). Compared with subclinical hypothyroidism,the levels of FT4,TC, TG,TSH、FT3 in clinical hypothyroidism patiens was higher (P 0.01 or P 0.05). Conclusion The level of lipids in subclinical hypothyroidism patients is abnormal and it amy be close to clinical hypothyroidism.
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In this artical, the pathologic alterations and clinical significance are described in patients with clinical manifestations of lupus nephritis (LN)(divided as groupA, 34 cases of clinical LN) and in those with systemic lupus erythematosus (SLE) but without renal damage proven by blood or urine tests (divided as groupB, 22 cases of subclinical LN). Renal biopsy had been done in these two groups and observed the pathological alterations in the kidneys. Results showed that damage rates in glomerulus were 100% in both groups, there was no significant difference between clinical LN and subclinical LN by WHO category, and damage in either renal tubule or interstitium was nearly similar in these two groups. It indicated that there has great significance in the primary prevention of renal protection by early renal biopsy to determine the pathological categories, early diagnosis and treatment of subclinical LN.
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To investigate the impact of subclinical synovitis detected by ultrasonography (US) on the ankles and feet of patients with rheumatoid arthritis.We retrospectively reviewed the data of patients (n = 59) who underwent US.The functional ability and quality of life (QoL) of patients in the subclinical group were impaired. While the physician visual analog scale (VAS) scores significantly decreased in the subclinical group, patient and pain VAS scores significantly decreased only in patients without synovitis.US-detected subclinical foot and ankle synovitis considerably affected patient functional status and QoL; however, it was often unnoticed by physicians.
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Abstract Objective The 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for rheumatoid arthritis (RA) refer to a possible use of ultrasound “for confirmation of the clinical findings.” We undertook this study to determine the optimized definition of ultrasound‐detected synovitis for the 2010 ACR/EULAR criteria and to assess the impact of its use on the accuracy of RA classification. Methods One hundred nine patients with musculoskeletal symptoms for ≤3 years were enrolled in the study. Patients underwent clinical, laboratory, radiographic, and comprehensive ultrasonographic assessments at baseline and received routine management from expert rheumatologists who were blinded to the ultrasound findings. Results Sensitivity and specificity of the 2010 ACR/EULAR criteria using different definitions of synovitis to identify patients who developed a disease requiring methotrexate (MTX) treatment within 1 year were 58.5% and 79.4%, respectively, for clinical synovitis (tenderness or swelling), 78.0% and 79.4%, respectively, for ultrasound‐detected synovitis with a gray‐scale (GS) imaging score ≥1 (GS ≥1 ultrasound synovitis), and 56.1% and 93.7%, respectively, for GS ≥2 ultrasound synovitis or a synovial power Doppler (PD) signal score ≥1 (GS ≥2/PD ≥1 ultrasound synovitis). Receiver operating characteristic curve analysis for the criteria scores revealed the largest area under the curve with GS ≥2/PD ≥1 ultrasound synovitis. Conclusion Ultrasound assessment improves the accuracy of the 2010 ACR/EULAR criteria for identifying patients with a disease requiring MTX treatment. Our data provide preliminary but vital information for the methodology to confirm the presence of synovitis using ultrasound in the 2010 ACR/EULAR criteria.
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Subclinical hypothyroidism and hyperthyroidism are diagnoses based on laboratory evaluation with few if any clinical signs or symptoms. Subclinical hypothyroidism is defined as an elevation in serum thyroid-stimulating hormone (TSH) above the upper limit of the reference range (0.45-4.5 mIU/L) with normal serum FT4 concentration; subclinical hyperthyroidism is defined as a decrease in serum TSH below the reference range with normal serum FT4 and T3 concentrations. Though these conditions represent the earliest stages of thyroid dysfunction, the benefits of detecting and treating subclinical thyroid disease are not well established. Most persons found to have subclinical thyroid disease will have TSH values between 0.1 and 0.45 mIU/L or between 4.5 and 10 mIU/L, for which the benefits of treatment are not clearly established; treatment may be beneficial in individuals with serum TSH lower than 0.1 mIU/L or higher than 10 mIU/L. This article illustrates approaches to managing patients with subclinical hypothyroidism and hyperthyroidism through 5 case scenarios that apply the principles of evidence-based medicine. Because of the substantial uncertainty concerning the consequences of untreated subclinical hypothyroidism and hyperthyroidism, as well as the benefit of initiating treatment, patient preferences are important in deciding on management of subclinical disease.
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