ObjectivesTo assess the importance of ultrasound (US) examination of joints in hands and feet in patients with early arthritis and perform comparative analysis of the diagnostic value of US examination for 8, 12 and 52 selected joints.Material and methods123 patients (87 women, 36 men) with arthritis lasting less than 12 months, naive to disease-modifying anti-rheumatic drugs and glucocorticosteroids. Necessary differential diagnostics was performed for each patient. After the preliminary analysis, 72 patients met the classification criteria for rheumatoid arthritis (RA) according to ACR/EULAR of 2010, and undifferentiated arthritis (UA) was diagnosed in 51 patients. UA patients were followed up after 6 and 12 months, and verification of the initial diagnosis yielded the following groups of patients: patients meeting classification criteria for RA, patients with maintained diagnosis of UA, patients in remission, and patients with other diagnoses. Ultrasound examination was performed considering the volume of joint effusion (JE), synovial membrane hypertrophy (GS), and synovial membrane hyperaemia assessed by power Doppler (PD). Results were assessed using the semi-qualitative scale. Coefficients being the sum of US scores for the assessment of JE, GS and PD for 52 and 12 joints in hands and feet, and 8 joints in hands were determined for the purpose of the study.ResultsIn patients meeting classification criteria for RA during the initial assessment the US examination yielded significantly higher PD-52I, PD-12I and PD-8I coefficients. In UA patients who were diagnosed with RA after 12 months, the GS-8I coefficient was significantly higher.ConclusionsUltrasonography is a valuable tool in diagnostics of early arthritis. The GS assessment has prognostic value for UA patients. The assessment of 8 or 12 selected joints is often sufficient for the diagnostics of patients with early arthritis.

Objective The purpose of this study was to characterize the role of eculizumab, a monoclonal antibody against the terminal complement component C5, in patients with catastrophic antiphospholipid syndrome (CAPS). Methods We present a case report of a patient with systemic lupus erythematosus (SLE) and CAPS treated with eculizumab, as well as results of a systematic review of the literature. Results Including our patient, we identified 11 case reports of patients with CAPS treated with eculizumab. All of them had partial or total remission of symptoms. Conclusion Data on eculizumab efficacy in CAPS are promising but are limited to single case reports. More studies are needed to develop evidence-based recommendations for eculizumab use in CAPS.

Objectives The aim of the study was to evaluate the frequency of anti-mutated citrullinated vimentin antibodies (a-Sa), anticitrullinated α-enolase peptide 1 antibodies (a-CEP-1), anti-filaggrin antibodies (AFAs), heterogeneous nuclear ribonucleoprotein compies/anti-RA33-antibodies (a-hnRNP/RA33), anti-carbamylated protein antibodies (a-CarP), and metalloproteinase (MMPs) activity in patients with early inflammatory arthritis (EIA). Methods Seventy-four patients with EIA: 51 diagnosed with RA (rheumatoid arthritis) and 23 with UA (undifferentiated arthritis), and 20 healthy volunteers were enrolled to the study. Inflammatory markers, rheumatoid factor (RF), and antibodies mentioned above were assessed in all patients. Results In the EIA group, we observed significantly higher concentration of a-CEP-1 (65.8 ± 111.6 RU/mL) than in controls (2.0 ± 0.0 RU/mL). In RF(+) RA patients, we observed higher concentration of a-Sa and a-CEP-1 than in other groups. A-Sa were positive in 69% of RF(+) RA, 37% of RF(−) RA, 26% of UA patients and in 10% of controls. A-CEP-1 were positive in 77% of RF(+) RA patients, in 56% of RF(−) RA patients, in 8.7% of UA patients, but they were negative in controls. In patients with RF(+) RA, positive a-CarP were present statistically significantly more often than in RF (−) RA patients. No statistically significant difference in frequency of a-hnRNP/RA33 and AFA between RF(+) RA, RF(−) RA, and UA was observed. Conclusions Our results suggest that a-CEP-1 may help in differentiation between RF(−) RA and UA. a-CEP-1 and a-Sa may be useful while diagnosing EIA. a-CarP may be used in differentiation of RA RF(−) and UA. However, a follow-up study is needed to evaluate the prognostic value of analyzed antibodies. Keywords Anti-carbamylated protein antibodies (a-CarP). Anti-citrullinated α-enolase peptide 1 antibodies (a-CEP-1). Anti-filaggrin antibodies (AFA). Anti-mutated citrullinated vimentin antibodies (a-Sa). Early inflammatory arthritis. Heterogeneous nuclear ribonucleoprotein compies/anti-RA33-antibodies (a-hnRNP/RA33). Metalloproteinases (MMP). Rheumatoid arthritis

Objectives: The aim was to assess of the morphology, intensity, and activity of changes in the first ultrasonographic (US) examination of hands and feet in patients with early arthritis (lasting up to 12 months) who were ultimately diagnosed with rheumatoid arthritis (RA). An attempt was made to demonstrate a correlation between the intensity of lesions in US and selected laboratory parameters. Material and methods: Ultrasonographic examination was performed using a LOGIC GE 500 device on a group of 60 patients with arthritis (46 women, 14 men) aged 18-80, previously untreated. In total, 3120 hand and feet joints were examined. The assessment focused on the presence of joint effusion, synovial proliferation and power Doppler signals (assessed on a semi-quantitative scale). Each patient underwent laboratory tests, necessary for making a diagnosis. In order to analyze the correlations between changes in US and laboratory parameters, erythrocyte sedimentation rate (ESR), reactive protein test (CRP), rheumatoid factor (RF), and anti-citrullinated protein antibodies (ACPAs) were used. Results: In the study group, the average duration of arthritis symptoms until the first US examination was 5.6 months. Among the 3120 examined hand and foot joints, deviations from the norm appeared in 1093 joints, synovial hypertrophy was found in 471 joints (grade 1 synovial hypertrophy was reported most frequently), while presence of signal in Power Doppler was revealed in 261 joints (grade 1 was observed most frequently). A statistically significant correlation was found between the intensity of changes in Power Doppler and CRP concentration. Conclusions: In patients with increased concentrations of CRP, we may expect arthritis of higher intensity, therefore, in order to prevent the progression of destructive changes, it is necessary to quickly implement effective disease-modifying antirheumatic treatment. The conducted research showed that the activity of joint inflammation is not affected by the values of ESR and the presence of RF or ACPAs.

BackgroundAs it is very important to identify patients with a high risk of developing rheumatoid arthritis (RA), new, diagnostic methods, evaluating the possibility of progression from undifferentiated arthritis (UA) to RA are needed.ObjectivesThe aim of this work was the evaluation of the frequency of rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) antibodies, mutated citrullinated vimentin antibodies (a-Sa), anti–CEP-1 antibodies, anti-filaggrin antibodies (AFA), heterogeneous nuclear ribonucleoprotein compies/anti-RA33-antibody (HnRNP/RA33), anti-CarP antibodies (a-Carp) in patients with early arthritis.Methods74 patients with early arthritis and 20 healthy volunteers were enrolled to the study. 51 patients were diagnosed with RA, 23 with UA. Exclusion criteria were the application of disease-modifying antirheumatic drugs or glucocorticosteroids. In all patients the following laboratory tests were performed: inflammatory markers, rheumatoid factor (RF) and antibodies mentioned above, together with necessary diagnostic that enables diagnosis.ResultsIn patients with early arthritis the sensitivity and specificity of the presence of RF was 69% and 95%, respectively, and of anti-CCP was 67% and 97%.In patients with early arthritis we observed significantly higher concentration of CEP-1 (65,8±111,6) than in the healthy group (2,0±0,0). In RF(+) RA patients we observed higher concentration of antibodies a-Sa and CEP-1 than in other groups.Antibodies a-Sa were positive in 69% of RF(+) RA patients, in 37% of RF(-) RA patients, in 26% of UA patients and in 10% of healthy people. In 8 aCCP (-) and RF(-) patients we observed the presence of a-Sa; 3 of them were diagnosed with RF(-) RA with and 5 with UA. Anti–CEP-1 antibodies were positive in 77% of RF(+) RA patients, in 56% of RF(-) RA patients, in 4,5% of UA patients, but their presence were not observed in the healthy people. In 8 aCPP (-) and RF (-) patients we observed positive anti–CEP-1 antibodies; 6 of them were diagnosed with RA, 2 of them with UA. Anti–CEP-1 antibodies were positive in 50% of RF(-) RA patients, in whom there was no aCCP nor RF, and only in 4,5% of UA patients.In case of marking a-Car-P, positive values were present in: the group of RF(+) RA in 40% of patients, in patients diagnosed with RF(-) RA in 6%, in case of UA in 22% of patients. In patients with RF(+) RA, positive anti-CarP antibodies are present statistically significantly more often than in the group of RF (-) RA patients (p<0,05). In case of marking hnRNP/RA33 and AFA no statistically significant differences between RF(+) RA, RF(-) RA and UA in their occurrence were observed. In patients with arthritis no correlation between smoking and analysed autoantibodies was observed. In smokers higher CRP concentration and ESR values was observed.ConclusionsOur results suggest that a-Sa and CEP-1 parameters allow to differentiate RF(+) RA, RF(-) RA and UA, but do not differentiate UA from RF(-) RA. Marking CEP-1 in patients with early arthritis may help in differentiation between...