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(1) Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease, primarily characterized by pain. A significant proportion of patients report symptoms suggestive of neuropathic pain. The objectives of this study were to investigate the presence of an increased cross-sectional area (CSA) of the palmar digital nerves by ultrasound in patients with active synovitis of the metacarpophalangeal joints and to identify potential predictors of such an increase. (2) Methods: An ultrasound examination of the clinically most affected hand (from the second to the fifth metacarpophalangeal joint) was performed. The presence of synovitis was scored using a 0–3 semiquantitative method for each joint. The CSA of each pair of palmar digital nerves was measured. (3) Results: A significant correlation was found between the sum of the CSAs of the nerves and the Clinical Disease Activity Index (CDAI) (r = 0.387), as well as with the ultrasonographic grading of synovitis (r = 0.381) both at the patient and the joint level. These two variables, aimed at measuring disease activity, along with male gender, are the only predictors of the CSA of the palmar digital nerves. (4) Conclusions: Synovial inflammation of the metacarpophalangeal joints is, therefore, a condition that can influence the CSA of the palmar digital nerves and may partially explain neuropathic pain in patients with RA. [ABSTRACT FROM AUTHOR]

Background and Purpose: Although fibromyalgia (FM) is considered a central sensitization syndrome, studies investigating peripheral nerves in this condition are not available. The primary objective of this study is to investigate the sonographic changes (ie, increased cross‐sectional area [CSA]), of peripheral nerves in patients with FM compared to healthy controls. The secondary objective is to identify potential clinical correlations associated with increased CSA in patients with FM. Methods: In this cross‐sectional observational study, consecutive female patients with FM underwent sonographic assessment using a standardized scanning protocol. The CSA of seven nerves was measured bilaterally at 11 anatomic sites by an experienced sonographer. Differences in CSA of nerves were compared with those of healthy subjects by one‐way analysis of variance. Patients underwent clinimetric evaluation aimed at investigating disease severity, neuropathic pain features, depression, anxiety, fatigue, and autonomic symptoms to explore the possible correlation between CSA and clinical features. Results: Forty‐seven patients and 20 healthy controls were enrolled. Differences in terms of increased CSA between patients and healthy controls were identified at multiple levels, mainly at the level of the sural nerve, vagus nerve, and sixth cervical nerve root (for all, p <.001). Sonographic findings, however, did not correlate with the clinical features explored. Conclusions: Patients with FM show higher CSA of nerves than healthy subjects. The increased CSA is most evident at the sural nerve, vagus nerve, and sixth cervical nerve root. Ultrasound, a relatively easy‐to‐use technique, could identify morphological changes, in peripheral nervous structures in patients with FM. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effectiveness of Janus-kinase inhibitors (JAKis) or abatacept (ABA) in patients with rheumatoid arthritis-interstitial lung disease (RA-ILD). Methods: Patients with RA-ILD receiving JAKis or ABA were retrospectively evaluated at baseline and after 18 months of treatment. A computer-aided method (CaM) was used to assess the extent of high-resolution computed tomography (HRCT) fibrosis percentage. According to HRCT fibrosis changes, patients were classified as "worsened" (progression of 15% or more), "stable" (changes within 15%) or "improved" (reduction of 15% or more). Correlations between RA characteristics and JAKis or ABA responses were studied using a multivariate regression model. Results: Seventy-five patients (69.3% women) were evaluated, 31 received a JAKi while 44 received ABA. In the JAKis group, five patients (16.1%) showed RA-ILD progression, 20 patients (64.5%) were considered stable, and six patients (19.4%) demonstrated RA-ILD improvement. In the ABA group, five patients (11.3%) showed RA-ILD progression, 32 patients (72.7%) were stable, and seven patients (16.0%) demonstrated RA-ILD improvement. In both groups, the percentage of current smokers was different between those classified as "worsened" and those classified as "improved/stable" (p = 0.01). In multivariate regression analysis, current smoking habit (p = 0.0051) and concomitant methotrexate treatment (p = 0.0078) were the two variables related to RA-ILD progression in ABA-treated patients, whereas in JAKis-treated patients, the only RA-ILD progression-related variable was disease duration of RA (p < 0.001). Conclusions: Treatment with JAKis or ABA was related to stability or improvement of RA-ILD in 83.9% and 88.6% of patients, respectively. RA duration is the only variable associated with worsening RA-ILD in JAKis-treated patients. [ABSTRACT FROM AUTHOR]

Introduction: Interstitial lung disease in rheumatoid arthritis (RA-ILD) is an extra-articular involvement that impairs the prognosis and for which there is still no well-coded treatment. The aim of this study was to evaluate abatacept (ABA) effectiveness and safety in patients with RA-ILD. Methods: RA-ILD patients who started ABA treatment were consecutively enrolled. Chest high-resolution computed tomography (HRCT), clinical, laboratory and respiratory function variables were collected at baseline and after 18 months of ABA treatment. HRCT abnormalities were evaluated using a computer-aided method (CaM). ABA response was established based on the change in the percentage of fibrosis evaluated at HRCT-CaM, dividing patients into "worsened" (progression ≥ 15%), "improved" (reduction ≥ 15%), and "stable" (changes within the 15% range). The multivariate regression model was used to assess the associations between RA characteristics and ABA response. Results: Forty-four patients (81% women, mean age 59.1 ± 8.0, mean disease duration of 7.5 ± 3.1 years) were studied. Five patients (11.4%) showed RA-ILD progression, 32 patients (72.6%) were considered stable, and 7 patients (16.0%) showed an RA-ILD improvement. The proportion of current smokers was significantly different between "worsened" patients, respect to those defined as "improved/stable" (p = 0.01). Current smoking habit (p = 0.005) and concomitant methotrexate treatment (p = 0.0078) were the two variables related to RA-ILD progression in multivariate regression analysis. Conclusion: Treatment with ABA is associated with a RA-ILD stability or improvement in the 88.6% of patients. Current smoking habit and concomitant treatment with methotrexate are the modifiable factors associated with RA-ILD worsening. Key Points • Abatacept plays a favourable role in the control of RA-ILD, with a significant worsening in only 11.4% of patients during a 18-month follow-up period. • The predictive variables related to RA-ILD progression during abatacept therapy are the concomitant treatment with methotrexate and current smoking habit. [ABSTRACT FROM AUTHOR]

To date, there is considerable evidence of the effectiveness of acupuncture in fibromyalgia syndrome (FM). However, it is not known in which body areas acupuncture is more effective. The objective of this study was to assess the improvements of pain induced by acupuncture in single body areas in patients with FM. In this open-label pragmatic study, FM patients in a state of high disease severity were consecutively enrolled and treated with a course of 8 weekly sessions of manual acupuncture. Patients were assessed with the Self-Administered Pain Scale (SAPS) of the Fibromyalgia Assessment Status at baseline and at the end of eight acupuncture sessions. Acupuncture sessions were all conducted with the same acupuncture formula (LV3, SP6, ST36, LI4, CV6, CV12, Ex-HN-3, and GV20) in each session and in each patient. Ninety-six FM patients completed the course of treatment. All the 16 body areas assessed by SAPS showed improvement in pain. A statistically significant improvement was achieved in 12 of the 16 body areas investigated, with the best results in abdomen and forearms (p = 0.001), while the worst results were registered for neck (p = 0.058), chest (p = 0.059), left buttock (p = 0.065), and right thigh (p = 0.052). The treatment has also shown significant effectiveness in improving fatigue and sleep quality (p < 0.0001). Acupuncture has a beneficial effect on pain in all body areas in FM patients with high disease severity, with the greatest effects in the abdominal region and in the forearms, allowing a personalization of the treatment. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the small joints of the hands and feet, characterized by pain, inflammation, and joint damage. In this context, magnetic resonance imaging (MRI) is useful to identify and monitor joint/tendon inflammation and the evolution of joint damage, playing a key role in treatment response evaluation, in addition to clinical measurements. Various methods to quantify joint inflammation and damage with MRI in RA have been developed, such as RA-MRI Score (RAMRIS), Early RA-MRI Score (ERAMRS), and Simplified RA-MRI Score (SAMIS). RAMRIS, introduced in 2002, offers an objective means to assess inflammation and damage via MRI in RA trials, encompassing findings such as synovitis, bone erosion, and edema/osteitis. Recently, an updated RAMRIS version was developed, which also includes the evaluation of joint space narrowing and tenosynovitis. The RAMRIS-5, which is a condensed RAMSIS version focusing on five hand joints only, has been proven to be a valuable resource for the semi-quantitative evaluation of RA joint damage, both in early and established disease. This narrative literature review will provide an overview of the MRI scoring systems that have been developed for the assessment of joint inflammation and structural damage in RA patients. [ABSTRACT FROM AUTHOR]

Aim: The aims of this prospective study were to determine the dimension of adherence in rheumatoid arthritis (RA) patients receiving subcutaneously administered anti‐tumor necrosis factor‐α (anti‐TNFα) agents and to evaluate the influence of injection site pain and skin perceptions following subcutaneous administration of anti‐TNFα drugs on patients' adherence. Method: An inception cohort of patients starting subcutaneously administered anti‐TNFα treatment was enrolled. Injection site pain perception was assessed through the Self‐Injection Assessment Pain Questionnaire (SIAPQ), and adherence to treatment was ascertained by the Compliance Questionnaire for Rheumatology (CQR5). Associations between beliefs and non‐adherence, and the influence of demographic (age, disease duration, educational level), clinical (body mass index, patient global assessment, physician global assessment, Numerical Rating Scale of pain, Health Assessment Questionnaire–Disability Index, Simplified Disease Activity Index, and comorbidities measured by the modified Rheumatic Disease Comorbidty Index), and radiographic (Simple Erosion Narrowing Score) variables were assessed using logistic regression models. Results: Adherence data over a 12‐month interval were available for 193 patients. Of these, 21.7% reported non‐adherence to anti‐TNFα therapy. No difference (P =.383) was found for anti‐TNFα drugs (adalimumab, etanercept, certolizumab pegol and golimumab). In the logistic model, age (P =.0029), higher disease activity (P =.020), low numbers of comorbidity conditions (P =.0004), injection site pain and skin perception (P =.0008), were significantly associated with increased likelihood of medication adherence. Conclusion: Adherence is influenced by both demographic characteristics (age) and clinical factors (disease activity, comorbidity burden and injection site pain and skin perception) in RA patients. [ABSTRACT FROM AUTHOR]

The treatment of fibromyalgia syndrome (FMS) is still far from being optimally coded, and pharmacological strategies are often unsatisfactory. Acupuncture plays a role among nonpharmacological intervention approaches; however, there is still no clarity as to when to integrate it into therapy. The objective of this study is to explore the role of acupuncture, in terms of efficacy on main disease severity measures and pain features, in patients with nonresponsive disease, defining nonresponsive FMS characterized by a revised Fibromyalgia Impact Questionnaire (FIQ-R) ≥39 and a Patient Health Questionnaire 15-item (PHQ15) ≥5 despite optimal drug therapy. Patients were treated with weekly sessions, for a total of eight acupuncture sessions. At the baseline and at the end of the treatment cycle, a comprehensive clinical evaluation was carried out to evaluate improvements in terms of disease severity and impact on neuropathic pain features (measured with the painDETECT questionnaire (PDQ)) and pain catastrophizing (measured with the Pain Catastrophizing Scale (PCS)). At the end of the eight-week treatment, patients experienced a significant improvement in all evaluated parameters (for FIQ-R, PDQ, and PHQ15 p < 0.0001 , for PCS p = 0.001). Of particular note is the effectiveness on manifestations that are difficult to treat such as neuropathic pain features and on negative psychological perceptions such as pain catastrophizing. It can be stated that acupuncture can be proposed also in phases of high severity of disease. Intervention with multimodal strategies, including acupuncture, could be of great benefit to patients. [ABSTRACT FROM AUTHOR]

Body mass index (BMI) demonstrated to influence the clinical response to different drugs in rheumatoid arthritis (RA). The aim of this study was to investigate the role of BMI in the achievement of remission in active RA patients starting the treatment with abatacept. Data regarding 130 RA patients enrolled in the UltraSound-CLinical ARthritis Activity (US-CLARA) study were retrospectively analyzed. Patients were assessed at baseline (when starting abatacept treatment) and at 3- and 6-months. An extensive clinimetric evaluation, including a new ultrasound (US)/clinical composite disease activity index, termed US-CLARA, was performed at every timepoints. Outcome of interest of the study was the impact of BMI on the achievement of the Disease Activity Score 28-joints erythrocyte sedimentation rate (DAS28-ESR) or the ACR/EULAR Boolean remission criteria at 6 month. At 6-month 26 out of 130 patients were defined as responders to abatacept. Comparing the baseline characteristics of responders to non-responders, US-CLARA showed a statistically significant difference between the two groups. The logistic regression analysis showed that the two indipendent variables, predictive of treatment response (keeping the DAS28-ESR and/or Boolean remission criteria as dependent variable), were the self-tender joint count assessment (p = 0.0412) and the ultrasound score (p = 0.0211). No other baseline variable, notably BMI, was associated to 6-month abatacept response. BMI does not influence the abatacept response in RA patients with active disease. During abatacept treatment, the clinical response can be achieved despite a condition of overweight or obesity. • Body mass index (BMI) is a predictor of treatment in Rheumatoid Arthritis. • Obese or overweight patients show a less favourable response to anti-TNF agents. • Abatacept efficacy is not affected by body weight in Rheumatoid Arthritis patients. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the present research were to assess the prevalence of frailty and its potential associated factors in a cohort of adult patients with rheumatoid arthritis (RA). Methods: Consecutive RA patients and healthy controls were assessed according to the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI), and classified as frail, pre-frail, or non-frail. Chi-square, analysis of variance (ANOVA), and multinomial logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest. Results: Two hundred and ten consecutive RA patients (65.7% female, mean age 60.4 years) and 100 healthy controls (63% female, mean age 59.1 years) were included. According to SHARE-FI criteria, 35 RA patients (16.6%) were categorized as frail, 68 (32.4%) as pre-frail, and 107 (51%) as non-frail, while 8 control subjects were categorized as frail, (8%), 17 as pre-frail (17%), and 75 as non-frail (75%) (chi-squared 12.8; P = 0.0016). The results from logistic regression analysis revealed that age (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.07–1.17; P < 0.0001), comorbidities (OR = 1.51, 95% CI = 1.01–2.27; P = 0.0446), and high disease activity (OR = 1.10, 95% CI = 1.04–1.16; P = 0.0006) were independently associated with frailty in RA. Conclusions: Frailty or pre-frailty are common in RA. The SHARE-FI may be a useful tool for the screening of frailty in RA and may summarize the results of a comprehensive RA assessment providing a marker of deficits accumulation. [ABSTRACT FROM AUTHOR]

Objective of this study is to evaluate the construct validity and the interpretability of the shortened Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) in the assessment of rheumatoid arthritis (RA) hand disability. Consecutive RA patients were assessed through the QuickDASH and other function and disease activity indices, respectively, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Recent-Onset Arthritis Disability questionnaire (ROAD). For each patient were evaluated the tender and swollen 28-joints counts. Interpretability was defined determining cut-off points of impairment in accordance to the Simplified Disease Activity Index (SDAI) definition of disease activity states. A total of 440 patients (89 men and 351 women, mean age of 57.0 ± 12.7 years) were enrolled. Following the SDAI definition, 98 patients (22.3%) resulted in REM, 115 subjects (26.1%) in LDA, 74 patients (16.8%) in MDA, and 153 subjects (34.8%) in HDA. Mean QuickDASH differed significantly between patients classified as remission (REM), low disease activity (LDA), moderate disease activity (MDA), or high disease activity (HDA) (p < 0.001). High correlations were found comparing QuickDASH to composite indices of disease activity and of physical health function: of special interest are the correlations between the comparable dimension of the QuickDASH and the ROAD Upper Extremity Function (rho = 0.876; p < 0.001). The cut-off points for functional categories (SDAI categories as external criterion) resulted: no impairment ≤ 13, 13 < low impairment ≤ 18.5, 18.5 < moderate impairment ≤ 31.5, and high impairment > 31.5. QuickDASH is useful in clinical practice, for its ease of administration, and positively correlates with the disease activity. It may be a surrogate for evaluating upper extremity impairment, disability index and disease control in RA patients. [ABSTRACT FROM AUTHOR]

To determine the contribution of fibromyalgia (FM) to the subjective components of the Disease Activity Score 28-joints (DAS28) in patients with rheumatoid arthritis (RA), and to analyse the discriminatory performance of the derived DAS28 patient-reported components (DAS28-P) to identify patients with fibromyalgic RA. Consecutive RA patients underwent clinical and clinimetric assessment. The DAS28-P index was derived from the components of the DAS28 scores by rearranging the DAS28-ESR formula. Patients were distinguished by the presence of FM. Student parametric t tests or Mann-Whitney non-parametric U tests were used to determine any between-group differences. Receiver operating characteristic (ROC) curve analysis was used to test the ability of the DAS28-P index to distinguish patients with RA and those with fibromyalgic RA. The study involved 292 RA patients (80.5% females, mean age 63 years) with a mean disease duration of 11.6 ± 8.5 years. Forty-three patients (14.7%) had concomitant FM, and significantly higher tender joint count (p < 0.001), pain numerical rating scale, global health status (p = 0.007), and DAS28 scores (p = 0.006) than those without FM. The DAS28-P values were also significantly higher in the patients with FM (0.68 ± 0.09 vs 0.58 ± 0.06; p < 0.001). The discriminatory power of the DAS28-P was very good (area under the ROC of 0.858, optimal cut-off value of 0.631). The presence of FM strongly influences the DAS28 results. The assessment of patient-reported components to the DAS28 through the DAS28-P can be a useful way to identify patients with fibromyalgic RA. [ABSTRACT FROM AUTHOR]

Objectives: To assess the validity of the rheumatoid arthritis impact of disease (RAID) for measuring disease activity of rheumatoid arthritis (RA) and to determine cut-off values for defining the disease activity states.Methods: A total of 622 RA patients from an European database have been included. Cross-validation was based on assessment of convergent and discriminant validity. Optimal cut-offs were determined against external criteria by calculating the respective 25th and 75th percentiles mean values of RAID. External criteria included definitions for remission (REM), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA), cut-offs of the 28-joint disease activity score-C-reactive protein (DAS28-CRP) score.Results: The RAID showed a moderate degree of correlation with respect to DAS28-CRP (rho=0.417; P<0.0001). The receiver operating characteristic (ROC) curves to discriminate the ability of RAID to distinguish patients with active and non-active disease was very good with an area under the curve (AUC) of 0.847 (95% confidence interval [CI]: 0.816 to 0.878; P<0.0001). Based on the distributions of RAID in the different disease activity groups, we propose the following cut-off values for REM: RAID ≤3; for LDA: RAID >3 and ≤4; for MDA: RAID >4 and ≤6; for HDA: RAID >6. Mean RAID differed significantly between patients classified as REM, LDA, MDA or HDA (P=0.001).Conclusions: The cut-offs revealed good measurement characteristics in cross-validation analysis, had great discriminatory performance in distinguishing patients with different levels of disease activity and are suited for widespread use in everyday practice application and research. [ABSTRACT FROM AUTHOR]

To develop and to test in a preliminary way a new self-administered screening tool, called DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire, in patients suffering from inflammatory bowel disease (IBD) not previously diagnosed as having a spondyloarthritis (SpA). DETAIL questionnaire was realized through the interrogation of 95 experts. They were asked to rate the importance of a list of items, derived from a review of the referral models of SpA, to detect the SpA manifestations in IBD patients. The six top-rated items composed the questionnaire, tested in IBD patients not already diagnosed having a SpA. One-hundred and twenty-eight patients were tested with the DETAIL questionnaire in the gastroenterology setting. After the rheumatologic assessment, in 21 (16.4%) subjects was diagnosed a SpA according to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. Of the six items of the DETAIL questionnaire, the best positive likelihood ratio (LR+) was found in item 2 (LR+ 3.82), exploring dactylitis, and in item 6 (LR+ 3.82) and item 5 (LR+ 3.40), two questions exploring inflammatory low back pain. Enthesitis (item 3—LR+ 2.87) and peripheral synovitis (item 1 - LR+ 2.81) gave similar results, while item 4, exploring the duration of low back pain, resulted in the worst performance (LR+ 1.99). Three of the six items answered in affirmative way gave a post-test probability ≥ 75%. The presence of a fibromyalgia represents a major confounder. The DETAIL questionnaire showed good screening properties that need to be confirmed in broader cohorts. [ABSTRACT FROM AUTHOR]

The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is an inclusive questionnaire, able to describe the total impairments and restrictions due to axial spondyloarthritis (axSpA). Considering the relationship between ASAS HI and the Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, the aim of this study is to establish the ASAS HI cut-off values for functioning categories employing the ASDAS-CRP disease activity states in axSpA patients. ASAS HI and ASDAS-CPR were obtained from 140 consecutive axSpA patients, divided in the four ASDAS-CRP disease activity categories. High and very high disease activity were considered together. The ASAS HI cut-offs were obtained from the arithmetic mean, rounded off to the closest whole number, of the 75th percentile mean value of a lower rank and the 25th percentile mean value of the adjacent higher rank. This approach was applied in the transition from inactive disease and moderate disease activity, and in the transition from moderate disease activity and high/very high disease activity. Twenty-three patients were classified as having inactive disease, 36 were classified as having moderate disease activity, and 81 were in a high/very high disease activity state. Using the approach of the 75th-25th percentile mean values of adjacent disease activity states, the ASAS HI cut-offs resulted: ≤4 to dinstinguish a normal functioning, >4 and ≤8 to distinguish a moderate impairment of functioning, and >8 to distinguish a severe impairment of functioning. ASAS HI seems a reliable tool to define functioning categories in patients with axSpA. [ABSTRACT FROM AUTHOR]

Background: The impact of axial spondyloarthritis (axSpA) is considerable in many aspects of the life. Over the last decades, many efforts have been conducted to develop useful tools for the evaluation of disease activity. However, since the development of Assessment of SpondyloArthritis international Society Health Index (ASAS HI), no specific freely questionnaire to describe the overall picture of impairments, limitations and restrictions in activities or social partecipation were available. The aims of this study were to test the feasibility, reliability, and construct validity of the ASAS HI, in order to compare its clinimetric properties with the current available measures of disease activity, functional limitation and health status assessments in patients with axSpA.Methods: A cohort of 140 consecutive axSpA has been the object of study. The feasibility has been determined by the percentage of patients who were able to complete the questionnaire by themselves and by the time employed to fill the ASAS HI. The reliability has been evaluated performing a test-retest of the questionnaire within a week. The construct validity was examined in three ways. First, we examined construct convergent validity by correlating the scores of the ASAS HI with the Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP/ESR, the Simplified Ankylosing Spondylitis Disease Activity Score (SASDAS), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Quality of Life scale (ASQoL) and the EuroQoL Five Dimensional Questionnaire (EQ-5D). Secondly, we have created patient groups based on the patients' activity ranks (ASDAS-CRP and SASDAS categorisation) within the cohort to assess discriminative accuracy. Additionally, to distinguish patients with active and non-active disease and to assess their respective cut-off points values, the receiver operating characteristic (ROC) curve analysis was used. Thirdly, we analyzed the contribution of demographic (age, sex, and disease duration) and clinical variables (number of comorbidity and disease activity by ASAS-CRP) to the attainment of an ASAS HI condition by stepwise logistic regression.Results: The mean time to complete the ASAS HI was 1.92 ± 0.76 min. Overall, the ASAS HI questionnaire was correctly completed by the majority of the patients (99,2 %). Coefficients of agreement between ASAS HI scores on first and second administrations were excellent and all items showed very good agreement (ICC = 0.976; range 0.966 to 0.982). The ASAS HI was correlated significantly with all other comparator scores (p <0.0001). The highest correlations were seen with ASQoL (rho 0.784; p <0.0001), BASFI (rho 0.671; p <0.0001) and SASDAS (rho 0.640; p <0.0003). On categorizing patients into different cut-off point of disease activity, with respect to the both ASDAS-CRP and SASDAS, ASAS HI scores were highly significantly different between the four categories (p <0.0001). An ASAS HI value of 4.0 resulted the cut-off with the highest combination of sensitivity and specificity (82.6 % and 86.3 %, respectively) to define the inactive disease. In the logistic regression model, high disease activity measured by ASDAS-CRP (coefficient 2.39; p <0.0001), was the only independent variable associated with ASAS HI.Conclusions: The results reported in this study confirm the feasibility, reliability and validity of the ASAS HI in Italian patients with axSpA. Even if ASAS HI is not a disease activity index, of particular interest appears the cut-off value of 4.0, under which could be defined the inactive disease. This value could represent an easily applicable starting point in daily clinical practice. [ABSTRACT FROM AUTHOR]

Background: Over the last few years, there has been a shift toward a more patient-centered perspective of the disease by adopting patient-reported outcomes. Touch-screen formats are increasingly being used for data collection in routine care and research.Objectives: The aim of this study is to examine the equivalence, reliability, validity and respondent preference for a computerized touch-screen version of the Psoriatic Arthritis Impact of Disease 12-item (PsAID-12) questionnaire in comparison with the original paper-and-pencil version, in a cohort of patients with psoriatic arthritis (PsA).Methods: One hundred and fifty-nine patients with PsA completed both the touch screen- and the conventional paper-and-pencil administered PsAID-12 questionnaire. Agreement between formats was assessed by intraclass correlation coefficients. Spearman's rho correlation coefficient was used to test convergent validity of the touch screen format of PsAID-12, while receiver operating characteristic curve analysis was performed to test discriminant validity. In order to assess the patient's preference, the participants filled in an additional questionnaire. The time taken to complete both formats was measured.Results: A high concordance between the responses to the two modes of the PsAID-12 tested was found, with no significant mean differences. Intraclass correlation coefficients between data obtained for touch-screen and paper versions ranged from 0.801 to 0.962. There was a very high degree of correlation between the touch-screen format of PsAID-12 and composite disease activity indices (all at a P level <0.0001), Health Assessment Questionnaire, and Physician Assessment of disease activity. The discriminatory power of the touch-screen format of PsAID-12, assessed using the minimal disease activity - Outcome Measurements in Rheumatology Clinical Trials criteria, was very good, with an area under the receiver operating characteristic curve of 0.937 and a resulting cutoff value of 2.5. The touch-screen questionnaire was readily accepted and preferred. The mean time spent for completing the questionnaire on touch screen was 2 minutes and on paper was 2.7 minutes.Conclusion: The touch-screen mode of administration of PsAID-12 can be a feasible and suitable alternative to the paper-and-pencil mode for the assessment of patients with PsA. [ABSTRACT FROM AUTHOR]

A 71-year-old man with osteoarthritis and chondrocalcinosis came to our observation developing a swelling in the groin region after a recent left colectomy for adenocarcinoma. The imaging techniques revealed the presence of an iliopsoas bursitis in connection with the hip. The synovial fluid analysis detected the presence of calcium pyrophosphate (CPP) crystals and allowed the final and unusual diagnosis of iliopsoas bursitis related to acute CPP crystal hip arthritis. [ABSTRACT FROM AUTHOR]

Background: Hip osteoarthritis (HOA) is a disease with globally rising incidence that leads to disability and morbidity, overall, in older populations, and might be primary or secondary to numerous risk factors. The most common idiopathic HOA is generally a diagnosis of exclusion, with pathogenetic mechanisms largely still misunderstood. We aimed to investigate the correlation between femoral–acetabular and spinopelvic anatomical and computed tomography (CT) characteristics, and the presence of primary OA. Methods: We retrospectively analyzed CT scans from 2019 to 2021, excluding patients under 45 years or with conditions affecting the pelvis, sacrum, or lower limbs. Femoral, acetabular, and spinopelvic parameters were measured; signs of OA were analyzed in the hip and knee joints. Patients were categorized into two groups: A (isolated hip OA) and B (no OA); patients with hip OA, also presenting knee OA, were excluded from this study. Results: In total, 232 cases were examined; statistical analyses compared CT parameters between 129 subjects from Group A and 103 patients of Group B. Group A showed a mean femoral version of 16 ± 4.53 degrees, significantly higher than Group B's 13.16 ± 4.37 degrees (p = 0.0001). Other parameters showed no significant differences. Conclusion: This study highlights an association between femoral version and primary hip OA. [ABSTRACT FROM AUTHOR]

Pain in the sacroiliac (SI) region is a common clinical manifestation, often caused by diseases involving the SI joints. This is typically due to inflammation or degenerative changes, while infections or cancer are less frequent causes. The SI joint is challenging to image accurately because of its distinct anatomical characteristics. For an accurate diagnosis, conventional radiography often needs to be supplemented with more precise methods such as magnetic resonance imaging (MRI) or computed tomography (CT). Sacroiliitis, a common presenting feature of axial spondyloarthritis (axial SpA), manifests as bone marrow edema, erosions, sclerosis, and joint space narrowing. Septic sacroiliitis and repetitive stress injuries in sports can also cause changes resembling inflammatory sacroiliitis. Other conditions, such as osteitis condensans ilii (OCI), can mimic the radiologic characteristics of sacroiliitis. Inflammatory lesions are diagnosed by concurrent erosions, hyperostosis, and ankylosis. Ligament ossifications or mechanical stress can also result in arthritic disorders. Determining the exact diagnosis can be aided by the distribution of the lesions. Inflammatory lesions can affect any part of the articulation, including the inferior and posterior portions. Mechanical lesions, such as those seen in OCI, often occur in the anterior middle region of the joint. In cases of idiopathic skeletal hyperostosis, ligament ossification is found at the joint borders. This pictorial essay describes common SI joint problems, illustrated with multimodal imaging data. We, also, discuss strategies for selecting the best imaging modalities, along with imaging pitfalls, key points, and approaches for treating patients with suspected inflammatory back pain. [ABSTRACT FROM AUTHOR]

Symptoms of fibromyalgia (FM) fluctuate and vary in severity. The current study aimed to evaluate the efficacy of palmitoylethanolamide (PEA) and acetyl-L-carnitine (ALC) in FM patients over a 24-month period and to investigate the mediating function of pain catastrophizing subdomains in unfavorable relationships with disease severity levels in patients with FM. Patients were evaluated at baseline, after 12 months, and after 24 months, using different patient-reported measures (FIQR, FASmod, PSD, and PCS) to distinguish different levels of FM disease severity. A reduction of 30% or more from baseline was considered clinically important ("markedly improved"). A multivariate analysis was performed to identify the variables predictive of an FIQR reduction. Twenty-two patients (28.6%) were classified as "markedly improved", 16 patients (20.8%) as "slightly/moderately improved", and 39 patients (50.6%) as "not improved." The FIQR, FASmod, and PSD scores were significantly reduced at 24 months. The pain magnification domain score of the PCS was the only variable predictive of worse FIQR scores (Wald coefficient: −2.94; p = 0.047). These results suggest a potential long-term therapeutic role for the PEA + ALC combination, with pain magnification being the primary predictor of poor efficacy. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the handgrip strength (HGs), assessed with a cylindrical-shape grip device, of fibromyalgia syndrome (FM) patients with healthy subjects and to demonstrate the relationship between HGs characteristics and disease severity. Consecutive female patients with FM were enrolled and compared to a group of healthy women. The correlations between HGs curve characteristics and disease severity indices were studied through the Spearman's rho correlation coefficients (rho). The HGs threshold distinguishing the FM presence was determined using the receiver operating characteristic (ROC) curves analysis. Multivariate regression analysis was used in order to assess the contribution of covariates on the HGs. 110 patients (mean age 53.8 ± 12.4 years) and 111 healthy controls have been enrolled. Altogether all parameters related to the analysis of HGs were worse in patients with FM. The HGs cut-off distinguishing the presence of a FM was 14.2 Kg. A negative correlation was found between disease severity indices and peak force (p < 0.001). Factors significantly associated with HGs area under the curve (AUC) in multivariate analysis were the Widespread Pain Index (WPI) (p = 0.003) and the revised Fibromyalgia Impact Questionnaire (FIQR) (p = 0.016). HGs is reduced in female FM patients and is inversely related to disease severity. The force-time curves analysis may be used as a complementary tool in the FM assessment and monitoring. [ABSTRACT FROM AUTHOR]

Objective: To assess the involvement of the atlantoaxial joint in patients with early rheumatoid arthritis (ERA) and to elucidate the risk profile for the individual patient.Materials and Methods: Consecutive ERA patients (disease duration < 12 months) were included in our study. A cervical spine magnetic resonance imaging (MRI) and X-rays (cervical spine, hands, wrists, and feet) were performed in all patients. The MRI features were correlated with clinical, radiological, and biochemical variables.Results: Fifty patients (13 men and 37 women) with a mean age of 58.2 years (range, 36-79 years) were included in the study. In 12 (24%) patients were detectable MRI findings suggestive of the craniovertebral junction involvement. Compared with patients without cervical involvement, the patients with atlantoaxial synovitis showed a significantly higher anti-citrullinated protein antibodies (ACPA) titer [mean 200.25 UI (SD 262.44) vs. mean 22.05 (SD 40.21) (p < 0.001)]; a worse Disease Activity Score 44 joints (DAS44) [mean 5.72 (SD 0.44) vs. mean 4.52 (SD 0.53) (p < 0.001)]; a worse Health Assessment Questionnaire Disability Index (HAQ-DI) [mean 1.55 (SD 0.37) vs. mean 1.09 (SD 0.33) (p < 0.001)], and a higher Simple Erosion Narrowing Score (SENS) [mean 15.83 (SD 4.52) vs. mean 7.71 (SD 3.43) (p < 0.001)]. The multivariate analysis revealed a meaningful relationship between atlantoaxial synovitis and ACPA, DAS44, and the presence of an erosive disease.Conclusions: The craniovertebral junction is frequently involved in ERA patients. ACPA, high disease activity, and erosive disease at baseline are predictors of atlantoaxial involvement. [ABSTRACT FROM AUTHOR]

Background: Psoriatic arthritis (PsA) is a heterogeneous condition that is difficult to assess. The goal of this research was to evaluate the clinimetric properties of the Psoriatic Arthritis 5-Thermometer Scales (PsA-5Ts), a new patient-reported outcome (PRO) to measure the overall health status in PsA patients. Methods: The PsA-5Ts were compared to composite measures of disease activity (DAPSA, PASDAS, CPDAI) and PROs (PsAID-12 and SF-36). The convergent validity was assessed through the Spearman's correlation coefficient and the discriminant validity through the receiver operating characteristic (ROC) curve analysis, applying the Minimal Disease Activity (MDA) as an external criterion. Results: The cross-sectional assessment included 155 patients. Significant high correlations were observed when comparing PsA-5Ts to composite indices of disease activity and PROs (all at significance levels of p < 0.0001). The PsA-5Ts subscales were highly significantly different in terms of MDA status (all at p < 0.0001). The PsA-5Ts had good discriminant validity like that of the DAPSA, CPDAI, PASDAS, and PsAID-12, and better than that of the SF-36, with an area under the ROC curve of 0.944 (65% CI 0.895–0.974). Conclusions: The PsA-5Ts are an easy-to-use PRO that can be integrated with disease activity indices in the assessment of PsA in daily clinical practice. [ABSTRACT FROM AUTHOR]

Objective. The main aim of this study was to compare ultrasonography (US) with conventional radiography for the assessment of joint damage in knee OA. Methods. A total of 166 knees of 84 patients (59 women and 25 men) with primary knee OA were included in this study. The femoral hyaline cartilage of the medial para-patellar aspect and the osteophytes of both the medial and lateral femoral condyle were assessed. The cartilage and osteophytes were both quantitatively and qualitatively assessed. The US assessment was feature-specifically compared with conventional radiography. Results. There was a strong correlation between the radiographic medial tibiofemoral narrowing grade and the US medial cartilage grade (rs = 0.7144, 95% CI: 0.6218, 0.7873, P < 0.0001). In the detailed analysis, US could assess cartilage damage more correctly by using the direct visualization technique. A strong correlation was also found between the radiographic and the US medial femoral osteophyte grade (rs = 0.7515, 95% CI: 0.6659, 0.8176, P < 0.0001) and between the radiographic and the US lateral femoral osteophyte grade (rs = 0.6947, 95% CI: 0.5941, 0.7739, P < 0.0001). US detected osteophytes in 46 sites at which conventional radiography did not detect any osteophytes. Conclusion. The present feature-specific comparison study provides evidence supporting the concurrent validity of US in the assessment of knee joint damage due to OA through its agreement with conventional radiography. Moreover, US was found to be a sensitive imaging technique for revealing cartilage damage and even minimal osteophytes, especially in the early radiographic stages of knee OA. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to explore additional evidence of convergent and discriminant validity of the Central Sensitization Inventory (CSI) in a large sample of subjects with fibromyalgia (FM). Methods: Patients were consecutively enrolled for a cross‐sectional assessment comprehensive of three FM‐specific measures (the revised Fibromyalgia Impact Questionnaire [FIQR], the modified Fibromyalgia Assessment Status [modFAS], and the Polysymptomatic Distress Scale [PDS]) and of CSI. To test the convergent validity, the Spearman's rho was used to measure the degree of correlation between the variables CSI and the FM‐specific measures. To assess discriminant validity, CSI scores were grouped according to FIQR disease severity states, and differences between these groups studied with the Kruskal–Wallis test. Interpretative cutoffs were established with the interquartile reconciliation approach. Results: The study included 562 FM patients, 199 (35.4%) were classified as having central sensitization syndrome (CSI ≥40). CSI was largely correlated with modFAS (ρ = 0.580; p < 0.0001), FIQR (ρ = 0.542; p < 0.0001), and PDS (ρ = 0.518; p < 0.0001). The differences between the CSI scores in accordance with the FIQR were significant (p < 0.000001). CSI cutoffs proposed for FM: 21 between remission and mild severity, 30 between mild and moderate severity, 37 between moderate and severe disease, and 51 between severe and very severe disease. Conclusion: The current study successfully showed additional evidence of the convergent and discriminant validity of the CSI in FM patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of 4 weeks of treatment with Janus kinase inhibitors (JAKis) on central sensitization (CS) and pain catastrophizing, and to determine the pain-related variables predictive of disease activity improvement, in patients with active rheumatoid arthritis (RA). Methods: Consecutive RA patients with active disease starting a JAKi have been enrolled in this prospective observational study. Patients have been assessed at baseline and after 4 weeks of treatment. The evaluation was comprehensive of disease activity [Simplified Disease Activity Index (SDAI) and ultrasonographic (US) score] and of questionnaires aimed at investigating primarily CS [Central Sensitization Inventory (CSI)] and pain catastrophizing [Pain Catastrophizing Scale (PCS)]. Differences (Δ values) between the final and baseline were studied with the t test, Δ values of the variables were correlated with each other using Pearson's test, and predictor variables for improvement in SDAI were also investigated using multivariate regression analysis. Results: A total of 115 patients were evaluated. Overall, all variables demonstrated significant improvement between baseline and final except the US score. In particular, CSI decreased from 36.73 to 32.57 (p < 0.0001), PCS decreased from 32.46 to 28.72 (p = 0.0001). ΔSDAI showed a significant correlation with both ΔPCS and ΔCSI (r = 0.466 and 0.386, respectively, p < 0.0001). ΔPCS was the only variable predictive of an improvement in SDAI (coefficient = 0.500, p = 0.0224). Conclusion: JAKis would appear to have a positive effect on pain-related variables, particularly CS and pain catastrophizing, for the genesis of which extra-synovial mechanisms are responsible. [ABSTRACT FROM AUTHOR]

Thenar and hypothenar hammer syndromes are uncommon conditions characterised by digital ischemia of the hand as a result of repetitive trauma at level of the thenar and/or hypothenar eminence and damage to the radial and/or ulnar arteries, respectively. The symptoms are related to the mechanism of the trauma and a Raynaud’s phenomenon can be predominant for a long time. The angiography is the “gold standard” imaging technique which allows to confirm the diagnosis. Therapeutic strategy depends on the type of the lesion and severity of symptoms and includes pharmacological (antithrombotic and thrombolytic drugs) and surgical treatments. The authors present a case of a 53-year-old man, carpenter by profession, with combined thenar and hypothenar hammer syndromes and Raynaud’s phenomenon, successfully treated with a short course of intravenous infusion of iloprost. [ABSTRACT FROM AUTHOR]

Background: Frailty is a construct recently introduced in the context of inflammatory joint diseases. To date, it is not clear if frailty can act as a negative factor in the achievement of comprehensive disease control (CDC) in patients suffering from rheumatoid arthritis (RA). Aim: To verify whether frailty is a factor hindering the achievement of CDC in patients with RA starting a biologic drug. Methods: RA patients requiring a treatment with a biologic drug were included. Patients were classified as achieving or not achieving CDC after 12 months of treatment. Patients were classified as non-frail, mildly frail, moderately frail and severely frail according to the Comprehensive Rheumatologic Assessment of Frailty (CRAF). Frailty was tested using the Mann–Whitney or Kruskal-Wallis test for continuous variables and chi-square test or Fisher's exact test for comparison with categorical variables. A multivariable logistic regression was performed to identify factors associated with prediction of CDC achievers. Results: A total of 214 RA patients were followed for 12 months, 14.5% achieved CDC. Eighty-four (39.3%) patients were non-frail, 57 (26.6%) were mildly frail, 14 (6.5%) were moderately frail and 59 (27.6%) were severely frail. The multivariable logistic regression analysis identified the CRAF score at baseline as an independent variable for CDC achievement at 12 months (p = 0.0040). Discussion: Frailty is a frequent condition in RA patients and reduces the chances of achieving CDC. Conclusions: Frailty, measured by CRAF, reduced the likelihood of CDC achievement in RA patients treated with a biologic agent. Key Points • Frailty is an under-researched condition in rheumatoid arthritis affecting more than 60% of patients. • Frailty is a condition that hinders the achievement of comprehensive disease control after 1 year of treatment with biological drugs in patients with rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

To investigate the relationship between handgrip strength (HGs) features, evaluated with an innovative cylindrical-shaped grip device, and demographic, anthropometric and clinical variables, in patients with rheumatoid arthritis (RA). Consecutive RA patients were prospectively enrolled for this cross-sectional study. For each patient were collected demographic, anthropometric, clinical data related to disease activity. HGs was assessed in terms of area under the force–time curve (AUC-FeT), peak grip force and time to reach the curve plateau. The correlations between the variables were studied with the Spearman's rho correlation coefficient. The receiver operating characteristic (ROC) curve analysis was used to test the discriminant accuracy of HGs features in identifying patients in moderate/high disease activity. A multivariate analysis was performed to estimate the contribution of covariates on the AUC-FeT. A significant correlation was found among AUC-FeT, age, Simplified Disease Activity Index (SDAI), Ultrasound-Clinical Arthritis Activity (US-CLARA) (all at p < 0.0001), and body mass index (BMI) (p = 0.0001). Any correlation was found between HGs and radiographic damage. The discriminatory power of AUC-FeT was good [area under-ROC curve = 0.810 (95% CI 0.746–0.864)]. Variables significantly associated with AUC-FeT in multivariate analysis were age (p = 0.0006), BMI (p = 0.012), gender (p = 0.004), SDAI (p = 0.047) and US-CLARA (p = 0.023). HGs is negatively influenced by demographic (gender and age), anthropometric (BMI), and disease activity variables (SDAI and US-CLARA). These findings highlight the role of HGs in RA patients' functional impairment and disability. [ABSTRACT FROM AUTHOR]

Objectives: To comparatively assess the sonographic spectrum of carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and in patients with idiopathic CTS. Methods: Fifty-seven RA patients and 25 idiopathic CTS patients were consecutively enrolled. The diagnosis of CTS in RA patients was made according to clinical history and examination. The following sonographic findings were assessed at carpal tunnel level: median nerve cross-sectional area (CSA) at the carpal tunnel proximal inlet, finger flexor tendons tenosynovitis, radio-carpal synovitis and intraneural power Doppler (PD) signal. Results: CTS was diagnosed in 15/57 RA patients (26.3%). Twenty-three RA wrists with CTS, 84 RA wrists without CTS and 34 idiopathic CTS wrists were evaluated. The average CSA of the median nerve was higher in idiopathic CTS than in RA wrists with CTS (17.7 mm2 vs 10.6 mm2, p < 0.01). A higher rate of inflammation of synovial structures (flexor tendons sheath and/or radio-carpal joint) was found in RA wrists with CTS compared with those without CTS (p = 0.04) and idiopathic CTS (p = 0.02). Intraneural PD signal was more common in CTS (in both RA and idiopathic CTS) wrists compared with wrists without CTS (p < 0.01). Conclusion: The sonographic spectrum of CTS in RA patients is characterized by an inflammatory pattern, defined by the presence of finger flexor tendons tenosynovitis and/or radio-carpal joint synovitis. Conversely, a marked median nerve swelling is the dominant feature in idiopathic CTS. Intraneural PD signal is a frequent finding in both conditions. Key Points • Carpal tunnel syndrome (CTS) associated with rheumatoid arthritis (RA) and idiopathic CTS have distinct ultrasound patterns. • The most characteristic sonographic features of CTS in RA patients are those indicative of synovial tissue inflammation at carpal tunnel level. Conversely, marked median nerve swelling is the dominant finding in idiopathic CTS. • Intraneural power Doppler signal is a frequent finding in both conditions. • In patients with CTS, differently from electrophysiology, US can provide clues prompting a rheumatology referral in case of prominent inflammatory findings at carpal tunnel level. [ABSTRACT FROM AUTHOR]

• Chest HRCT allows quantification of ILD both by visual and computed-aided methods. • Computed-aided method shows a better performance than the visual scoring system. • Computed-aided method improves sensitivity and repeatability of quantitative changes. • Computed-aided method is easier and faster to perform. The aim of this study was to evaluate and compare the internal and external responsiveness of a computed-aided method (CaM) with a conventional visual reader-based score (CoVR) to measure interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) on high resolution computed tomography (HRCT). Forty-five patients were evaluated in this retrospective cohort. HRCTs were collected at baseline and after 1 year. HRCT abnormalities were evaluated according to a CoVR (Warrick's method) and a quantitative CaM. Internal 1-year responsiveness was tested with a standardized mean response (SRM). Analyses of the receiver operating characteristic curves (ROCs) evaluated the sensitivity and specificity of the two methods to discriminate between clinically relevant progression and no relevant progression, using expert judgment as the gold standard (external responsiveness). In one year, lung involvement was stable/improved in 17 of the 45 patients (37.8%) and worsened in 28 patients (62.2%). HRCT scores changed moderately over the follow-up period. Using SFM, CaM was significantly more responsive in detecting changes due to treatment than the CoVR method. Likewise, in the analysis of the ROC curve, CaM scores showed the highest performance (AUC ROC CaM vs. CoVR, 0.951 vs. 0.807; p = 0.0065). Quantitative analysis of CaM was more responsive than the CoVR method to accurately evaluate and monitor SSc-ILD progression or response to therapy. [ABSTRACT FROM AUTHOR]

Déterminer la prévalence des signes échographiques spécifiques de la présence de dépôts de cristaux d'urate monosodique au sein de la région poplitée chez les patients atteints de goutte ; évaluer la précision diagnostique de l'échographie dans la détection des cristaux d'urate monosodique au niveau de la région poplitée, du tendon rotulien et du cartilage hyalin du genou ; déterminer la corrélation entre les images échographiques de la région poplitée et la présentation clinique. Une évaluation échographique bilatérale de la région poplitée, du tendon rotulien et du cartilage hyalin des condyles fémoraux a été réalisée chez 47 patients consécutifs atteints de goutte et 37 sujets témoins. Les signes échographiques spécifiques de la présence de cristaux d'urate monosodique (agrégats, tophus et signe du « double contour ») ont été identifiés selon les définitions des mesures de résultat en rhumatologie. Une ou plusieurs anomalies échographiques (agrégats et/ou tophus) ont été retrouvées au niveau d'au moins une fosse poplitée chez 23 des 47 patients atteints de goutte (48,9 %) et chez 4 des 37 témoins (10,8 %) (p < 0,001). La sensibilité, la spécificité et l'odds ratio diagnostique des images échographiques de la région poplitée, du tendon rotulien et du cartilage hyalin des condyles fémoraux étaient respectivement de 0,49/0,89/7,9, 0,62/0,81/6,9 et 0,30/1,0/32,0. Une corrélation significative a été établie entre l'aspect échographique de la région poplitée et les antécédents d'atteinte inflammatoire du genou (p < 0,001, V = 0,644) ainsi que le nombre de crises de goutte au cours de l'année précédente (p = 0,012, V = 0,434). Cette étude ouvre de nouvelles perspectives sur l'évaluation échographique des patients atteints de goutte en soulignant l'intérêt clinique de la région poplitée comme site de recueil des cristaux d'urate monosodique autrement indétectables. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate in a preliminary way a novel radiographic scoring system for psoriatic arthritis (PsA), called Simplified Psoriatic Arthritis Radiographic Score (SPARS).Materials and Methods: Radiographs of hands and feet were obtained from consecutive PsA patients and assessed by two readers. For each joint (30 joints in the hands, ten joints in the feet), the combination of the erosions, joint narrowing space (JNS) and bony proliferation (BP) has been assessed, giving a value of 1 for erosions presence, 1 for JNS presence, and 1 for BP presence (SPARS score range, 0-120). Reliability was assessed by calculating the intraclass correlation coefficient (ICC) and smallest detectable difference (SDD) of the readings. To determine the convergent validity, SPARS was compared to the modified Sharp/van der Heijde Score (mSvdHS) and to the Ratingen scoring system (PARS).Results: One-hundred and five hands and feet radiographs have been assessed. The inter- and intra-rater reliability were excellent (inter-rater reliability 0.934, and intra-rater reliability for both readers 0.845 and 0.876). The SDD for the average SPARS scores of the two readers was 8.0. SPARS correlated strongly with mSvdHS (r = 0.926; p < 0.0001), and PARS (r = 0.904; p < 0.0001). The mean time to score each of the mSvdHS, PARS, and SPARS was 14.4, 10.1, and 4.5 min, respectively.Conclusions: The SPARS properties are close to those of the mSvdHS and PARS and is quicker to calculate. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of the ultrasound findings indicating monosodium urate crystal deposits at the popliteal groove region in patients with gout; to evaluate the diagnostic accuracy of ultrasound in detecting monosodium urate crystal deposits at the popliteal groove region, patellar tendon and the knee hyaline cartilage; to investigate the correlation between the ultrasound findings at the popliteal groove region and the clinical features.Methods: Bilateral ultrasound assessment of the popliteal groove region, patellar tendon and femoral condyles' hyaline cartilage was performed on 47 consecutive patients with gout and 37 controls. The ultrasound findings indicating monosodium urate crystals (aggregates, tophi and "double-contour" sign) were identified according to the Outcome Measures in Rheumatology definitions.Results: One or more ultrasound abnormalities (aggregates and/or tophi) were found in at least one popliteal groove region in 23 out of 47 patients with gout (48.9%) and in 4 out of 37 controls (10.8%) (P < 0.001). Sensitivity, specificity and diagnostic odds ratio of the ultrasound findings at the popliteal groove region, patellar tendon and at the femoral condyles' hyaline cartilage were 0.49/0.89/7.9, 0.62/0.81/6.9 and 0.30/1.0/32.0, respectively. There was a significant correlation between the ultrasound findings at the popliteal groove region and history of knee inflammatory involvement (P < 0.001, V = 0.644) and number of gouty "attacks" in the previous year (P = 0.012, V = 0.434).Conclusions: This study provides new insights into the ultrasound assessment of patients with gout, highlighting the clinical relevance of the popliteal groove region as an area of collection of otherwise undetectable monosodium urate crystals. [ABSTRACT FROM AUTHOR]

Abstract Stability and performance of long term semi-continuous Anaerobic Digestion of food waste at semi-pilot scale is here evaluated based on the integration of multiple lines of evidence. In order to elucidate the main microbial components, the core microbiome dynamics were assessed by high-throughput 16 S rRNA gene sequencing over the reactor operation together with the data related to the AD performances. The experimental reactor, after a successful start-up, was operated for more than 200 days at a moderate OLR (Organic Loading Rate) of 1.6 ± 0.4 g VS L−1d−1. The availability of readily biodegradable substrate, in particular carbohydrates, favored the fermentative functional redundancy of bacteria promoting the rapid accumulation of acetate first, and propionate afterwards, due to limited methanogenesis. The prolonged operation, despite the moderate OLR, nurtured propionate accumulation, because H 2 concentration exceeded the level capable to render the reaction endergonic, hampering the propionate uptake process. The application of a Pulsed Feeding strategy increased the hydrogenotrophic Methanomicrobiales favoring the consumption of propionate most likely through hydrogen utilization. Highlights • Semi-continuous long-term AD of Food Waste at OLR of 1.6 g VS L−1d−1 is presented. • Dominance of fermentative bacteria by continuous feeding affected stability. • The prolonged operation, despite moderate OLR, nurtured propionate accumulation. • Pulsed Feeding strategy increased hydrogenotrophic Methanomicrobiales. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune arthritis, occurring in patients with psoriasis (Pso), that may affect the whole musculoskeletal system but also nails, eye, and gastrointestinal tract. Dermatologists and rheumatologists usually manage Pso and PsA separately, but early diagnosis and integrated management could achieve better outcomes of both skin and musculoskeletal manifestations, thus improving the health-related quality of life (HRQoL) of patients. In this work, we have described a model of integrated dermo-rheumatologic approach for the early diagnosis of PsA and to present the outcomes of the multidisciplinary management of PsA patients after 48 weeks of follow-up. Pso patients complaining musculoskeletal symptoms were enrolled in a DErmo-Rheumatologic Clinic (DERC) in order to screen, classify, and treat patients with PsA, employing an operative working procedure and a specific flowchart. The integrated dermatologic and rheumatologic management of PsA patients allowed a prompt establishment of the diagnosis and the best therapeutic approach in these patients, with a significant improvement of skin and articular diseases and, eventually, a consistent amelioration of HRQoL. Dermatologists and rheumatologists usually manage the “psoriatic disease” in separated outpatient clinics. In our study, we have demonstrated that a combined DERC, by means of a tight cooperation between the dermatologist and the rheumatologist, which use a specific working procedure and treatment flowchart, may achieve the optimal clinical management of these patients, with a consistent clinical remission of the disease and a significant amelioration of the HRQoL. [ABSTRACT FROM AUTHOR]

To investigate the influence of fibromyalgia (FM) on achieving remission defined on the basis of the Simplified Disease Activity Index (SDAI) remission criteria in patients with long-standing rheumatoid arthritis (RA). This observational longitudinal cohort consisted of long-standing RA patients being treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs). After 6 months of follow-up, the patients fulfilling or not fulfilling the remission criteria were identified and compared with each other in terms of the presence of FM, neuropathic pain, and other comorbidities. At the end of the 6-month observation period, 24 of the 117 patients (20.4%) met the SDAI remission criteria. Logistic regression analysis showed that the modified Rheumatic Disease Comorbidity Index (mRDCI) ( p = 0.0001), the FM presence ( p = 0.0001), and the 36-item short-form health survey Mental Component Summary (SF-36 MCS) Score ( p = 0.0088) were the strongest predictors of not being in SDAI remission. None of the patients with concomitant FM (17.1%) achieved SDAI remission. In comparison with the non-FM patients, the patients with RA and FM patients had worse scores on the SF-36 MCS ( p = 0.011), on the sleep Visual Analogue Scale (VAS) ( p = 0.018), on the self-counts of tender joints ( p = 0.039), and on the PainDetect Questionnaire (PDQ) ( p = 0.001). To avoid over treatment, an assessment of FM should be considered in RA patients who do not fulfil the remission criteria. [ABSTRACT FROM AUTHOR]

Background: The advent of Internet and World Wide Web has created new perspectives toward interaction between patients and healthcare professionals. Telemonitoring patients with rheumatoid arthritis (RA) is an emerging concept to guide the collaborative management treatment and improve outcomes in patients. The objective of this study was to investigate whether an intensive treatment strategy, according to a telemonitoring protocol, is more effective than conventional management strategy in reaching remission and comprehensive disease control (CDC) after 1 year in early rheumatoid arthritis (ERA) patients.Methods: Forty-four ERA patients were randomly allocated into two groups: the telemonitoring intensive strategy (TIS) group (group 1) or the conventional strategy (CS) group (group 2). Three patients refused to participate. In group 1 (n = 21), a remote monitoring system of disease activity, in combination with protocolised treatment adjustments aiming for remission was applied. In group 2 (n = 20), patients were treated according to daily clinical practice, with regular evaluation of disease activity, but without protocolised treatment adjustments. A telemedical care called "REmote TElemonitoring for MAnaging Rheumatologic Condition and HEaltcare programmes" (RETE-MARCHE), was developed to perform the remote monitoring.Results: A higher percentage of patients in the TIS group achieved CDAI remission vs patients in the CS group (38.1 % vs 25 % at year 1, p <0.01). Time to achieve remission was significantly shorter in the group 1 than in the group 2, with a median of 20 weeks vs a median over 36-weeks (p <0.001). Concordantly, the patients in group 1 showed a greater improvement (p <0.001), compared with group 2 in terms of functional impairment (71.4 % vs 35 %) and radiological damage progression (23.8 % vs 10 %), resulting in a greater rate of CDC (19.4 % vs 5 %).Conclusions: According to our results, an intensive treatment strategy by telemonitoring leads to more effective disease remission and more rapid CDC than treatment according to conventional management strategy in ERA.Trial Registration: Trial Registration Number: ISRCTN13142685 Date of registration: March, 17(th) 2016. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed (a) to evaluate an improved quantitative lung fibrosis score based on a computer-aided diagnosis (CaM) system in patients with systemic sclerosis (SSc),—related interstitial lung disease (SSc-ILD), (b) to investigate the relationship between physiologic parameters (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO]), patient-centred measures of dyspnea and functional disability and CaM and visual reader-based (CoVR) methods, and (c) to identify potential surrogate measures from quantitative and visual HRCT measurement. Methods: 126 patients with SSc underwent chest radiography, HRCT and PFTs. The following patient-centred measures were obtained: modified Borg Dyspnea Index (Borg score), VAS for breathing, and Health Assessment Questionnaire-Disability Index (HAQ-DI). HRCT abnormalities were scored according to the conventional visual reader-based score (CoVR) and by a CaM. The relationships among the HRCT scores, physiologic parameters (FVC and DLCO, % predicted) results and patient-centred measures, were calculated using linear regression analysis and Pearson’s correlation. Multivariate regression models were performed to identify the predictor variables on severity of pulmonary fibrosis. Results: Subjects with limited cutaneous SSc had lower HAQ-DI scores than subjects with diffuse cutaneous SSc (p <0.001). CaM and CoVR scores were similar in the 2 groups. In univariate analysis, a strong correlation between CaM and CoVR was observed (p <0.0001). In multivariate analysis the CaM and CoVR scores were predicted by DLco, FVC, Borg score and HAQ-DI. Age, sex, disease duration, anti-topoisomerase antibodies and mRSS were not significantly associated with severity of pulmonary fibrosis on CaM- and CoVR methods. Conclusions: Although a close correlation between CaM score results and CoVR total score was found, CaM analysis showed a more significant correlation with DLco (more so than the FVC), patient-centred measures of perceived dyspnea and functional disability. Computer-aided tomographic analysis is computationally efficient, and in combination with physiologic and patient-centred measures, it could allow a means for accurately assessing and monitoring the disease progression or response to therapy. [ABSTRACT FROM AUTHOR]

Objective. To provide information on the value of Patient Acceptable Symptom State (PASS) in rheumatoid arthritis (RA) by the identification of PASS thresholds for patient-reported outcomes (PROs) composite scores. Methods. The characteristics of RA patients with affirmative and negative assignment to PASS were compared. Contributors to physician response were estimated by logistic regression models and PASS thresholds by the 75th percentile and receiver-operating characteristic (ROC) curve methods. Results. 303 RA patients completed the study. All PROs were different between the PASS (+) and PASS (−) groups (p<0.0001). The thresholds with the 75th percentile approach were 2.0 for the RA Impact of Disease (RAID) score, 2.5 for the PRO-CLinical ARthritis Activity (PRO-CLARA) index, and 1.0 for the Recent-Onset Arthritis Disability (ROAD) questionnaire. The cut-off values for Clinical Disease Activity Index (CDAI) were in the moderate range of disease activity. Assessing the size of the logistic regression coefficients, the strongest predictors of PASS were the disease activity (p=0.0007) and functional state level (0.006). Conclusion. PASS thresholds were relatively high and many patients in PASS had moderate disease activity states according to CDAI. Factors such as disease activity and physical function may influence a negative PASS. [ABSTRACT FROM AUTHOR]

Ultrasound (US) is a promising tool for assessing sarcopenia. We aimed to test in the rheumatology setting two US scanning protocols to measure muscle thickness (MT) at the anterior thigh level and to assess their feasibility and reliability. In the first phase of the study, three rheumatologists performed a US examination on 19 consecutive patients adopting two scanning protocols, namely the anterior superior iliac spine (ASIS) and the greater trochanter techniques. After consensus was obtained on the easiest scanning protocol to perform, two rheumatologists adopted only the ASIS technique in 40 consecutive patients. MT measurements were recorded as well as the time needed to complete each scanning protocol bilaterally. The median time needed to complete the US examination was under 5 minutes for each of the two techniques, with no significant difference between them (p = 0.64). In the first phase, we found an excellent inter-observer reliability of the proposed scanning protocols, with a higher but nonstatistically significant intraclass correlation coefficient (ICC) for the ASIS technique compared with the greater trochanter technique (ICC 0.97 vs. ICC 0.92, p = 0.05). The ASIS technique had a significantly higher intra-observer reliability (ICC 0.97 vs. ICC 0.92, p < 0.01). In the second phase, the ASIS technique confirmed on a larger sample its excellent inter-observer reliability, with an ICC of 0.96. The present study presents a novel tool for assessing sarcopenia and provides evidence in favor of feasibility and reliability of US measurement of MT at the anterior thigh level in rheumatology setting.Key Points• This study demonstrates that ultrasound (US) measurement of muscle thickness at the anterior thigh level is highly reliable, especially for the “anterior superior iliac spine (ASIS)” technique.• The short time needed to complete the US assessment highlights the feasibility of the proposed scanning protocols.• The simplicity and conciseness of the proposed techniques will allow other researchers and clinicians to use it for a fast assessment of sarcopenia.Key Points• This study demonstrates that ultrasound (US) measurement of muscle thickness at the anterior thigh level is highly reliable, especially for the “anterior superior iliac spine (ASIS)” technique.• The short time needed to complete the US assessment highlights the feasibility of the proposed scanning protocols.• The simplicity and conciseness of the proposed techniques will allow other researchers and clinicians to use it for a fast assessment of sarcopenia. [ABSTRACT FROM AUTHOR]

The interest in tree phenology monitoring is increasing because this trait is a robust indicator of the impacts of climate change on natural and managed ecosystems. Different approaches to monitor phenology at different spatial scales, from in situ monitoring to remote sensing, are used to investigate spring and/or autumn phenological changes. In Mediterranean area, most of phenological changes occur during cloudy periods (spring and autumn), leading to a loss of information also for very high temporal resolution satellites. Instead, cloud-uninfluenced sensors, such as radar sensors, can allow to bypass this problem and produce a temporally continuous coverage. In this paper, we analyzed the spring phenology of two European beech (Fagus sylvatica L.) populations, located at different latitudes in Mediterranean area. Weekly in situ monitoring of leaf-out has been correlated with data collected by Synthetic Aperture Radar. Spring phenological phases were monitored in situ following a modified BBCH-code with a 5-scores scale (from 1 - buds closed and covered by scales, to 5 - leaf completely unfolded). The score 3 (young leaves starting to emerge from the bud) was considered the bud break. Different site conditions based on aspect (northern and southern) and altitudinal gradient (high and low altitude) have been considered. The aim was to test and implement a new methodology able to decrease the frequency of the field sampling, using remote data, to extend more detailed information on geographical scale, and to reconstruct past phenology. Results showed a statistically significant different length of the vegetative spring period, spanning from dormant buds, up to leaves completely unfolded, between sites. Through Synthetic Aperture Radar estimation, this study demonstrates that leaf-out can be monitored with an extreme accuracy. The phenophase score 4 and 5 estimation showed the best performance (RMSE < of 4 days), phenophases score 2 and 3 showed promising performances (4 days < RMSE <5 days), while phenophases score 1 seems to be not easily detectable, although it can be extrapolated with an RMSE <6 days. This radar approach fixes the cloud problem typical of multispectral approach and very frequent in phenophase change periods in Mediterranean climate. This study promotes the proposed remote sensing approach as a very useful tool to monitor growing season starting in remote areas, helping to reduce in situ observations and allowing past phenology reconstruction. • Sentinel-1 proved to be an operative monitoring tool for beech leaf phenology. • Beech leaf emerging and unfolding were the best detected phenophases. • Phenophases detecting errors ranged between 3 and 5 days. • A human assisted was the best performing approach. • Lower altitudinal belts were synchronised due to similar ecological condition. [ABSTRACT FROM AUTHOR]

Aim: To assess the impact of baseline modified Rheumatic Disease Comorbidity Index (mRDCI) a simple comorbidity count, on overall survival of treatments with biological drugs in patients affected with Rheumatoid Arthritis (RA), Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) in real‐world settings. Methods: Patients (nr. 635) with RA (nr. 214), SpA (nr. 213) and PsA (nr. 208) starting a first biological drug were retrospectively analysed. mRDCI was scored at baseline, and disease characteristics were recorded at entry and at last observation. Drug retention was analysed using Kaplan‐Meier curves. Cox regression models were used to estimate the association of baseline mRDCI with drug discontinuation and clinical outcomes, the achievement of clinical remission based on 28 joint‐Disease Activity Score (DAS28) <2.6 for RA and PsA, and on Ankylosing Spondylitis‐C‐reactive protein Disease Activity Score (ASDAS‐CRP) <1.3 for SpA. Results: Baseline mRDCI significantly correlated with the number of biological drug switches (rho 0.26). Persistence on biologic therapy was significantly higher in patients with mRDCI=0 (96.4%), than in those with mRDCI ≥2 (83.9%). Patients without comorbidities showed significantly higher drug survival rate in PsA (P = 0.0001) or SpA (P = 0.02), but not in RA. mRDCI was also found to be a predictor of definitive drug discontinuation (HR: 1.53) and of failure to achieve remission in RA (HR: 0.66) or PsA (HR: 0.77), and in SpA (HR: 0.43). Conclusions: This study provided evidence that baseline mRDCI negatively impacts the persistence on biologic treatments and clinical outcomes in patients with RA, SpA and PsA in real‐life settings. [ABSTRACT FROM AUTHOR]