Significant advances have occurred in our understanding of the pathogenesis of knee osteoarthritis (OA) and some recent trials have demonstrated the potential for modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply knee imaging in knee OA trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for magnetic resonance imaging (MRI)); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance (QA)/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations.
Imaging of hip in osteoarthritis (OA) has seen considerable progress in the past decade, with the introduction of new techniques that may be more sensitive to structural disease changes. The purpose of this expert opinion, consensus driven recommendation is to provide detail on how to apply hip imaging in disease modifying clinical trials. It includes information on acquisition methods/ techniques (including guidance on positioning for radiography, sequence/protocol recommendations/ hardware for MRI); commonly encountered problems (including positioning, hardware and coil failures, artifacts associated with various MRI sequences); quality assurance/ control procedures; measurement methods; measurement performance (reliability, responsiveness, and validity); recommendations for trials; and research recommendations.
Tremendous advances have occurred in our understanding of the pathogenesis of hand osteoarthritis (OA) and these are beginning to be applied to trials targeted at modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply hand imaging assessments in disease modifying clinical trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for MRI); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations.
Multicentric reticulohistiocytosis (MRH) is a rare multisystem, granulomatous debilitating disease. It affects the skin with a nodular diffuse dermatitis and the joints with a severe, potentially deforming, and handicapping arthritis. No standardized therapy exists, it is a disease with heterogeneous severity, and therefore, a diversity of therapeutic responses has been published.Current experience with anti-tumor necrosis factor agents in disease-modifying antirheumatic drug-refractory MRH cases is encouraging, and other agents such as bisphosphonates have proven effective as well. Histological analysis of the granulomatous inflammatory lesions have shown the presence of cytokines including tumor necrosis factor α, interleukin 1, and interleukin 6; the presence of the latter makes tocilizumab a plausible alternative.In this article, we report a 35-year-old woman with MRH refractory to a combined scheme of prednisone and methotrexate, both at high doses, and who received tocilizumab achieving remission on both cutaneous and articular symptoms. Our patient markedly improved by the second infusion (8 mg/kg monthly), and after 9 infusions, she remained asymptomatic; no toxicity was detected. Tocilizumab could be an alternative for disease-modifying antirheumatic drug-refractory MRH.
On page 699 the published text conflates the fixed flexion and MTP techniques so that neither are correct. The published text states: "The most commonly used techniques used at this time are the fixed-flexion PA view and the fluoroscopically aligned Lyon-Schuss PA view, with the use of a SynaFlexer positioning frame (BioClinica (formerly Synarc), San Francisco, CA). In the Lyon Schuss view, the patellae and thighs are in contact with the film cassette and coplanar with the tips of the great toes. In the (MTP) fixed flexion view the patellae are in contact with the cassette and aligned vertically with the first MTP joints with the feet externally rotated 5. This results in reproducible flexion of the knee at approximately 20. The X-ray beam is angulated 10 caudad and centered on a reproducibly identifiable point in the popliteal fossa of a single knee or midway between the two knees at the level of the popliteal fossa if both knees are imaged simultaneously, with the aim of aligning the beam tangential with the floor of the medial tibial plateau. The Lyon Schuss technique uses the same positioning and beam centering, but fluoroscopically aligns the anterior and posterior rims of the medial tibial plateau.The published text should read: "The most commonly used techniques used at this time are the fixed-flexion PA view and the fluoroscopically aligned Lyon-Schuss PA view, with the use of a SynaFlexer positioning frame (BioClinica (formerly Synarc), San Francisco, CA). In the fixed-flexion view, the patellae DOI of original article: http://dx.
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