PD positivity in tendons and joints is an independent risk factor of flare in patients with RA in clinical remission. Musculoskeletal ultrasound evaluation is a valuable tool to monitor and help decision making in patients with RA in clinical remission.
US-detected tenosynovitis is a frequent finding in RA patients in clinical remission and associates with unstable remission.
BackgroundRemission is the target of treatment in rheumatoid arthritis (RA). In clinically-defined remission, subclinical disease activity may persist leading to flare and joint damage progression. Musculoskeletal ultrasonography (MSUS) is a good candidate to overcome the limitations of clinimetric indexes. The role of MSUS synovitis is well-known in the literature but no data are available for tenosynovitis.ObjectivesThe study aims to evaluate the association between US synovitis (S) and tenosynovitis (T) and 6-month flare in RA patients in clinical remission.MethodsThe STARTER study is a multicentre cohort study promoted by the Italian Society for Rheumatology. Ultrasonographers were selected by an inter-reader reliability exercise. Consecutive patients with RA and clinical remission underwent a full clinical evaluation and Grey Scale (GS) and power Doppler (PD) US exam (assessing -S and -T) at wrists, MCP, PIP and extensor/flexor tendon sheets. Six-month flare was defined as: 1) increase of >1.2 or >0.6 if final DAS28>3.2; 2) change in treatment; 3) change of >4 points in the flare questionnaire (FQ) if FQ<4 at baseline. The relationships between presence of GS-T/-S, PD-T/-S were evaluated by logistic models, presented as odds ratios (OR) and 95%CI, adjusted for pre-specified confounders.ResultsA total of 427 patients were included in the analyses: 113 (26.5%) men, mean (SD) age 56.6 (13.4), median (IQR) disease duration 7.3 (3.8-13.5) years, median (IQR) remission duration 12 (8-24) months, RF positive 287 (67.4%), mean (SD) DAS28 2.2 (0.8), median (IQR) HAQ 0.125 (0-0.375), on DMARDs 322 (75.4%), on biologics 183 (42.9%), on glucocorticoids 187 (43.8%). GS-T was present in 198/373 (53.1%) patients, PD-T in 88/372 (23.7%) while GS-S in 270/368 (73.4%) and PD-S in 171/372 (46.5%). The association between US variables and flare is reported in the Table.ConclusionsMSUS PD-S confirms its predictivity on flare defined according to DAS28 definitions while PD-T is more specifically associated with patient-related flare and symptoms exacerbation. US-T should be take into account in the management of RA patients in clinical remission.Disclosure of InterestNone declared
tomatologia dolorosa con allodinia e iperalgesia, si associano altri disturbi, quale astenia, alterazioni del sonno, rigidità mattutina, e/o altre sindromi disfunzionali quali dismenorrea, colon irritabile, cefalea tensiva, dispepsia funzionale gastrica, disordine temporo-mandibolare (2). La SFp interessa maggiormente il sesso femminile, con una prevalenza nella popolazione generale che è valutata tra lo 0,3 e il 3,3% (3). Dal punto di vista patogenetico, mentre una causa muscolare non sembra essere determinante, sempre più evidenze correlano la sintomatologia fibromialgica a un disturbo della percezione dolorosa del sistema nervoso centrale (4, 5). Svariati studi psicologici sul malato fibromialgico hanno evidenziato la frequente comorbidità con ansia e depressione, senza mai chiarire però, se tali patologie ne fossero la causa o il risultato (6, 7). Recentemente sono stati evidenziati gli stretti rapporti di causa-effetto tra lo stress e il dolore (8). Per eventi stressanti s'intendono tutti gli stimoli che comportano la necessità di riadattamento dell'individuo e che provocano un cambiamento dell'o -INTRODUZIONE L a sindrome fibromialgica primaria (SFp) è una controversa sindrome dolorosa cronica, a eziologia sconosciuta, frequentemente correlabile alle reazioni di adattamento allo stress, caratterizzata da un dolore muscolo-scheletrico diffuso e dalla presenza di punti algogeni (tender-points), evocabili alla pressione in corrispondenza di specifiche sedi tendinee e muscolari, e da una varietà di sintomi clinici d'accompagnamento. La sua diagnosi è essenzialmente clinica e si basa sui criteri dell'American College of Rheumatology (ACR) del 1990 che prevedono la presenza da almeno tre mesi, di un dolore muscolo-scheletrico diffuso e dalla presenza di dolorabilità dei tender-points in numero (almeno 11/18) e modalità sufficienti (1). Alla sin- Reumatismo, 2008; 60(4)
Background Chronic widespread pain (CWP) is a healthcare problem that has a considerable social impact because it is frequent (a prevalence of 4.7-11.2%) and causes a poor quality of life. It can be a consequence of many disorders; however, there are few reports concerning its prevalence during the course of other diseases. Systemic sclerosis (SSc) is a multisystem autoimmune disease characterised by vascular injury and progressive skin and organ fibrosis. The involvement of internal organs is responsible for higher morbidity and mortality rates, and the patients quality of life can be worsened by the presence of CWP. Objectives The aim of this study was to compare the prevalence of CWP in patients with limited (l-SSc) or diffuse SSc (d-SSc) and healthy controls. Methods All of the patients were evaluated in terms of the disease activity, markers of inflammation, the presence of antibodies, serum vitamin D levels, and disease duration. All of the subjects (patients and controls) completed a psychic stress test (the Kessler 10-item test), a test of the quality of sleep and fatigue (Flinder’s Fatigue Scale), and a test of catastrophism. Results The study evaluated 48 patients with SSc (42 females and 6 men; mean age 59.4±13.5, range 24-81), 31 with l-SSc and 17 with d-SSc (disease duration 8±5 years). The overall prevalence of CWP in the patients was 27.1%, much higher than that expected in the general population. The prevalence of CWP in the patients with l-SSc and d-SSc was respectively 17.6% and 32.3%, but the difference was not statistically significant. There was no correlation between the prevalence of CWP and the dergree of cutaneous involvement (modified Rodnan Skin Score), but there was a correlation with older age (p=0.033) and the ESR (p=0.041). Logistic regression showed that the only variable favouring the development of CWP was the presence of anti-centromeric antibodies (ACAs, p=0.08). Conclusions The higher prevalence of CWP among patients with SSc does not correlate with the clinical manifestations of the disease. However, it does correlate with advanced age and the presence of inflammation. The presence of ACAs is a risk factor for CWP, which suggests that patients with l-SSc develop CWP more frequently than those with d-SSc. Disclosure of Interest None Declared
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