Clinical rheumatology
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Clinical rheumatology · Oct 2010
Correlation between synovitis detected on enhanced-magnetic resonance imaging and a histological analysis with a patient-oriented outcome measure for Japanese patients with end-stage knee osteoarthritis receiving joint replacement surgery.
Osteoarthritis (OA) is a disease that primarily results in the degeneration and destruction of the articular cartilage. However, synovitis that occurs secondarily by this primary phenomenon is crucial for both the structural and symptomatic progression of the disease. The Japanese Knee Osteoarthritis Measure (JKOM) was created as an outcome measure for Japanese patients with knee OA. ⋯ Neither the synovitis scores evaluated by the histological analysis nor those by a Gd-MRI correlated with the pain VAS score (n = 34, r = 0.25, p = 0.18 and r = 0.08, p = 0.75, respectively) and WOMAC (n = 14, r = 0.35, p = 0.22 and r = 0.45, p = 0.16, respectively) of the patients. However, they significantly correlated with the JKOM score of the patients (n = 34, r = 0.55, p = 0.001 and r = 0.71, p = 0.001, respectively). The severity of synovitis in OA was closely correlated with the current functional impairment and disability of the patients receiving TKA with end-stage knee OA.
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Clinical rheumatology · Oct 2010
ELISPOT-IFN-gamma assay instead of tuberculin skin test for detecting latent Mycobacterium tuberculosis infection in rheumatic patients candidate to anti-TNF-alpha treatment.
In rheumatic patients candidate to anti-TNF-alpha treatment, there is an increased risk of developing tuberculosis (TB). The tuberculin skin test (TST), the standard diagnostic test for latent tuberculosis infection (LTBI), suffers low specificity and sensitivity. Here, we compared the performance characteristics of an in-house ELISPOT-IFN-gamma assay (using a restricted pool of Mycobacterium tuberculosis-specific peptides or MTP) to TST for the diagnosis of LTBI in 69 rheumatic patients candidate to anti-TNF-alpha treatment and in 60 healthy LTBI individuals. ⋯ The agreement between the two tests was poor (k = 0.341, 95% CI = 0.060 to 0.622) and the test of symmetry was not significant (P = 0.8). Considering the ELISPOT assay, rheumatic patients had a reduced number of spot-forming cells after stimulation of lymphocytes with PHA or PPD when compared with healthy LTBI individuals. Thus, the ELISPOT-IFN-gamma assay performs better than the TST in recognizing patients with LTBI, on one hand reducing the number of patients submitted to isoniazid prophylaxis, and on the other hand, since the assay is less biased by immunosuppressive regimens than TST, recognizing LTBI patients among those with a negative TST response.
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Clinical rheumatology · Oct 2010
Mycophenolate mofetil in systemic sclerosis-associated interstitial lung disease.
This study aimed to assess the effect of mofetil mycophenolate (MMF), an inhibitor of lymphocyte proliferation, on lung function and skin in patients with systemic sclerosis (SSc)-associated interstitial lung disease (SSc-ILD). In this retrospective study, we reviewed the medical files of 10 patients with SSc-ILD (eight females, 10 patients with diffuse SSc; mean age, 59.7 +/- 12.7 years; disease duration, 7.7 +/- 4.7 years). Patients were treated with MMF (2 g/day) for 12 months. ⋯ There was a significant increase in forced vital capacity and a nonsignificant increase in carbon monoxide diffusing capacity at 12 months in patients on MMF (p = 0.04 and 0.66, respectively). There was no effect on mRTSS. MMF stabilizes lung function of SSc-ILD after 12 months of treatment.
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Clinical rheumatology · Sep 2010
Left atrial volume and N-terminal pro-B type natriuretic peptide are associated with elevated pulmonary artery pressure in patients with systemic sclerosis.
Early detection of pulmonary hypertension (PH) in patients with systemic sclerosis (SSc) is essential as it leads to substantial morbidity and mortality irrespective of its etiology. The aim of our study was to determine whether noninvasive biochemical and/or echocardiographic indices can predict the presence of PH in these patients. We prospectively studied 66 patients (mean age of 57.7 +/- 12.1 years, 63 women) with SSc without clinical manifestations of heart failure. ⋯ In multivariate analysis, NT-proBNP, LA volume, and right ventricular MPI were independent predictors of PH in SSc patients. LA volume and NT-proBNP may be useful noninvasive markers for the prediction of elevated pulmonary artery pressure in patients with SSc. These parameters should be considered when assessing this population for risk stratification and for identification of patients demanding further investigation and institution of specific therapy for the disease at the time when it is most likely to be effective.
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Clinical rheumatology · Aug 2010
Randomized Controlled TrialAdditional effect of pulsed electromagnetic field therapy on knee osteoarthritis treatment: a randomized, placebo-controlled study.
The aim of this study was to evaluate if pulsed electromagnetic field therapy (PEMF) has additional effect on the classical physical treatment of knee osteoarthritis (OA) composed of hot pack, therapeutic ultrasound, and terminal isometric exercises. Forty patients (29 women and 11 men), ages 44 to 78 (mean age was 61.3 +/- 7.8 years) were included in our study. Patients with knee osteoarthritis [Kellgren-Lawrence criteria grade 2 and above and an average pain intensity of 40 or more on a 100-mm visual analog scale (VAS)] recruited from outpatient physical medicine and rehabilitation clinic were randomly assigned to receive PEMF or sham PEMF treatment in addition to their physical therapy. ⋯ There were no statistically significant differences between groups in WOMAC pain, stiffness, and physical function scores after treatment (p = 0.906, p = 0.855, p = 0.809, respectively). There was neither difference in concomitant used acetaminophen dose in both groups (p = 0.289). The results of this study show that PEMF does not have additional effect on the classical physical treatment in reducing symptoms of knee OA.