A serum bilirubin measurement and the use of the critical bilirubin level of 6 mg/dL in the first 24 hours of life will predict nearly all of the term newborns who will have significant hyperbilirubinemia and will determine all those who will require a phototherapy treatment later during the first days of life.

Background:Radiographic severity of ankylosing spondylitis (AS) shows such great variance that some patients never develop syndesmophytes throughout the entire disease span, whereas some develop bamboo spine relatively early.Objective:To study the association between ERAP1, IL23R and PTGER4 single nucleotide polymorphisms (SNPs) and radiographic severity in AS patients.Methods:rs27044 and rs30187 (ERAP1), rs11209032 (IL23R) and rs10440635 (PTGER4) SNPs were genotyped in 235 AS patients fulfilling the modified New York criteria. Patients were classified as mild- and severe-AS according to modified Stoke AS spinal score (mSASSS). Mild-AS is defined as having mSASSS of “0” following at least 10 years of disease duration. Severe-AS is defined as having mSASSS of >20 (patients with mild vertebral changes (i.e. squaring or erosions) were omitted for clear stratification) regardless of disease duration.Results:The genotype distributions and allele frequencies of ERAP1 rs27044 and rs30187, IL23R rs11209032 and PTGER4 rs10440635 SNPs were similar in mild- (n=171, mSASSS=0, 55.6% HLA-B27 positive) and severe-AS patients (n=64, mSASSS=48.5±17.8, 73.4% HLA-B27 positive). After adjustment for clinical differences between groups (gender, disease duration, HLA-B27 and smoking status) by logistic regression analysis, none of the alleles in the investigated SNPs were found to be associated with radiographic severity of AS.Conclusion:In radiographically well-categorized AS patients, ERAP1 rs27044 and rs30187, IL23R rs11209032 and PTGER4 rs10440635 SNPs are not found to be associated with radiographic severity of AS.

Objective.To identify and synthesize the best available evidence on the application of musculoskeletal (MSK) ultrasound (US) in patients with systemic lupus erythematosus (SLE) and to present the measurement properties of US in different elementary lesions and pathologies.Methods.A systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Original articles were included that were published in English between August 1, 2014, and December 31, 2018, reporting US, Doppler, synovitis, joint effusion, bone erosion, tenosynovitis, and enthesitis in patients with SLE. Data extraction focused on the definition and quantification of US-detected synovitis, joint effusion, bone erosion, tenosynovitis, enthesitis, and the measurement properties of US according to the OMERACT Filter 2.1 instruments selection.Results.Of the 143 identified articles, 15 were included. Most articles were cross-sectional studies (14/15, 93%). The majority of the studies used the OMERACT definitions for ultrasonographic pathology. Regarding the measurement properties of US in different elementary lesions and pathologies, all studies dealt with face validity, content validity, and feasibility. Most studies achieved construct validity. Concerning the reliability of image reading, 1 study (1/15, 7%) assessed both intraobserver and interobserver reliability. For image acquisition, 4 studies (4/15, 27%) evaluated interobserver reliability and none had evaluated intraobserver reliability. Criterion validity was assessed in 1 study (1/15, 7%). Responsiveness was not considered in any of the studies.Conclusion.This literature review demonstrates the need for further research and validation work to define the involvement of US as an outcome measurement instrument for the MSK manifestations in patients with SLE.

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BackgroundDuring the last decade, it has been shown that cardiovascular disease (CVD) in systemic sclerosis (SSc) is increased and accounts for ∼30% of the SSc mortality. But, whether this is due to accelerated atherosclerosis and how to detect patients with high risk are still unclear.ObjectivesTo determine the frequency of subclinical atherosclerosis in patients with SSc compared to rheumatoid arthritis (RA) and to determine the ability of CV risk indices in detecting high risk SSc patients.MethodsEighty one SSc patients (F/M=74/7; age 49.7±12.1 years, limited/diffuse=49/32) and 80 age-sex matched RA patients (F/M=73/7;age 50.1±10.5 years) without CVD were assessed. All patients were evaluated with carotid ultrasonography (US). Carotid intima-media thickness (cIMT) >0.90 mm and/or carotid plaques were used as the gold standard test for subclinical atherosclerosis and high CV risk (US+). Systematic Coronary Risk Evaluation (SCORE), QRisk II and 2013 American College of Cardiology/American Heart Association (ACC/AHA) 10-year atherosclerotic CV disease risk (ASCVD) indices were calculated.ResultsFifteen (18.5%) SSc and 19 (23.8%) RA patients had subclinical atherosclerosis (P=0.41). The mean cIMT (mm) was also similar in both groups (0.67±0.15 vs 0.68±0.15, P=0.74). None of the CV risk factors in SSc patients were worse than RA patients except for lower HDL-chol levels (table 1),but total-chol/HDL-chol was similar (3.6±0.9 vs 3.5±1). When US+ and US- SSc patients were compared, it was observed that US+ SSc patients were older, had more pulmonary arterial hypertension (PAH), elevated ESR, HT and less immunsuppressive usage (Table 2). In multivariate analysis, age (OR=1.1, 95% CI [1.02-1.8], P=0.014), elevated ESR (OR=9.3, 95% CI [1.6-55.5], P=0.014) and PAH (OR=4.8, 95% CI [1.12-20.8], P=0.035) were independently associated with subclinical atherosclerosis. Concerning CVD risk indices, of the 15 US+ patients only 0, 1 (6.7%) and 3 (20%) patients were classified as high CV risk according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively.Table 1.CV risk factors of SSc and RA patientsSSc patients (n=81)RA patients (n=80)PDisease duration, years9.7±8.710.9±7.80.10Obesity, n (%)16 (19.8)28 (35)0.03Ever smoked, n (%)28 (34.6)24 (30)0.53Hypertension, n (%)21 (25.9)28 (35)0.21Diabetes mellitus, n (%)6 (7.4)10 (12.5)0.28LDL-chol106.5±37.3113.0±33.90.25HDL-chol54.0±18.561.1±16.60.011Triglycerides122.4±58.4117.7±61.60.63Metabolic syndrome, n (%)24 (29.6)24 (30)0.95ConclusionsSubclinical atherosclerosis in SSc is as frequent as in RA in which accelarated atherosclerosis is clearly defined. Atherosclerosis in SSc is independently associated with age, elevated ESR and PAH. CV risk indices, SCORE, QRisk II and ACC/AHA 10-year ASCVD risk are considerably insufficient in SSc to detect patients with subclinical atherosclerosis.Disclosure of InterestNone declared