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Objective: We conducted a questionnaire survey within a standard clinical setting to clarify that picture superiority effect (PSE) could be obtained by musculoskeletal ultrasound (MSKUS) examination. Methods: One hundred patients with rheumatoid arthritis or arthralgia, who visited the Rheumatology Unit, Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, and received first-time MSKUS from June 2017 to August 2017, were sequentially requested to complete an anonymous questionnaire based on their experiences of the explanation with or without MSKUS. MSKUS was implemented as point-of-care ultrasonography (POCUS) or on the other reserved examination day. Results: We obtained answers from all patients (n = 100); 80% or more subjects strongly agreed that the explanation complemented with MSKUS contributed to 'easier understanding,' 'better communication,' and 'preference for MSKUS-available hospital' (p < .001). This agreement was also observed in elderly patients and when MSKUS was implemented as POCUS. There was no correlation between the number of examined joints (r = 0.18, p = .15), time required for MSKUS (r = -0.17, p = .09), the severity of the MSKUS results (r = -0.06, p = .52), and degree of agreement. Conclusion: MSKUS addition has shown to offer PSE, which contributes to patients' understanding and experience of improved communication. We should acknowledge the effects of PSE by MSKUS and utilize it for informed consent and shared decision-making in musculoskeletal symptomatic patients. [ABSTRACT FROM AUTHOR]

Objective: To clarify the clinical features of systemic lupus erythematosus (SLE) patients, factors associated with flares, and changes over time. Methods: Patients having SLE with a visiting history were entered into the Juntendo University Database of Erythematosus. We included 423 cases in the long-term follow-up analysis, and 383 cases were followed for 10 years after the initiation of any therapeutic intervention (comparative analysis: 1973-1982, 82 cases; 1983-1992, 141, and 1993-2002, 160). We assessed changes in the patients' background characteristics, disease symptoms, flare rates, etc. Results: Among the 423 cases, the mean follow-up period was 25.9 years, and mean number of flares was 0.51. Of those, 31.9% had ≥ 1 flares. Thrombocytopenia at onset contributed to the flares. For disease symptoms at onset, a recent trend in increasing thrombocytopenia was observed. The combination rate of immunosuppressive agents for diseases other than lupus nephritis was slightly increased, and there was no improvement until the first flare or in the flare rate. Conclusions: Thrombocytopenia at onset is predictive factor for flares. Since SLE is a diverse disease with varying symptoms at recurrence, the treatment guidelines should be improved for thrombocytopenia from a long-term perspective. [ABSTRACT FROM AUTHOR]

Objectives: To determine which grade of ultrasound (US) synovitis corresponds to clinically involved joints in rheumatoid arthritis (RA) and develops a new US-adjusted composite measure. Methods: Clinical and US examinations were performed on 137 patients with RA (28 joints). Synovial effusion, hypertrophy, and blood flow were semiquantitatively graded from 0 to 3 using gray scale (GS) and power Doppler (PD) modes. We calculated US-adjusted simple disease activity index (SDAI) and assessed feasibility, and external validity by comparing with erythrocyte sedimentation rate (ESR), and modified health assessment questionnaires (MHAQ). Results: GS ≥2 and PD ≥0 corresponds to clinically swollen joints, and GS ≥2 and PD ≥1 corresponds to tender joints. The US-adjusted SDAI showed the highest correlation when USdetermined swollen joints were defined as PD ≥2 with ESR, and GS ≥3 and PD ≥2 with MHAQ. A feasible US-adjusted SDAI examining only clinically involved joints still showed a higher correlation with ESR and MHAQ than SDAI. Conclusion: Our composite measure complemented by US only for clinically involved joints is feasible and reliable for monitoring disease activity. [ABSTRACT FROM AUTHOR]

Objective. To determine the degree of contribution and the contributing factors of ultrasound in the diagnosis of rheumatoid arthritis (RA) in daily clinical practice and the predictive diff erences depending on seropositivity. Methods. We included 122 patients who presented with the main complaint of finger and/or wrist joint pain but for whom no definite diagnosis was reached or treatment strategy was provided. Ultrasound was performed on at least 22 joints (both wrist joints, proximal interphalangeal joint, and metacarpophalangeal joints), and patients were followed for ≥6 months. Factors contributing to RA diagnosis were determined and compared between seropositive and seronegative RA patients. Results. RA was diagnosed in 52 of 122 patients, in whom the American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) classification criteria (odds ratio [OR] = 4.74, P = 0.01) and gray scale (GS) grade of 3 (OR = 3.64, P = 0.04) for ≥ 1 joint were the contributing factors. In seropositive RA, the ACR/EULAR criteria (OR = 15.53, P < 0.001) and power Doppler (PD) ≥ 2 for ≥ 1 joint (OR = 10.48, P = 0.0048) were the contributing factors. In seronegative RA, PD ≥ 1 for ≥ 1 joint contributed the most (OR = 20.00, P = 0.0044), but the ACR/EULAR criteria did not contribute to RA diagnosis (P = 0.57). Conclusion. Ultrasound findings contributed to RA diagnosis in clinical practice. The contributing factors are diff erent in the presence or absence of seropositivity, and ultrasound complementation was particularly useful in seronegative RA patients. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to identify causes of false-positives in ultrasound scanning of synovial/tenosynovial/bursal inflammation and provide corresponding imaging examples. Methods: We first performed systematic literature review to identify previously reported causes of false-positives. We next determined causes of false-positives and corresponding example images for educational material through Delphi exercises and discussion by 15 experts who were an instructor and/or a lecturer in the 2013 advanced course for musculoskeletal ultrasound organized by Japan College of Rheumatology Committee for the Standardization of Musculoskeletal Ultrasonography. Results: Systematic literature review identified 11 articles relevant to sonographic false-positives of synovial/tenosynovial inflammation. Based on these studies, 21 candidate causes of falsepositives were identified in the consensus meeting. Of these items, 11 achieved a predefined consensus (-80%) in Delphi exercise and were classified as follows: (I) Gray-scale assessment [(A) non-specific synovial findings and (B) normal anatomical structures which can mimic synovial lesions due to either their low echogenicity or anisotropy]; (II) Doppler assessment [(A) Intra-articular normal vessels and (B) reverberation)]. Twenty-four corresponding examples with 49 still and 23 video images also achieved consensus. Conclusions: Our study provides a set of representative images that can help sonographers to understand false-positives in ultrasound scanning of synovitis and tenosynovitis. [ABSTRACT FROM AUTHOR]