This study was conducted to assess ultrasound (US) and clinical changes of Baker's cyst (BC) of patients with knee osteoarthritis (OA) after steroid injection. Patients with knee OA complicated with symptomatic BC (40) were treated with US-guided direct (posterior) aspiration. The injection of 40 mg triamcynolone acetonide was in 20 patients direct into the BC and in other 20 subjects intra-articular (anterior). BC diameters (longitudinal, transverse, and thickness) were measured and followed up with US at baseline, 2, 4, and 8 weeks after injection. Swelling, pain, and range motion were scored at clinical examination with Rauschning and Lindgren classification (RLC, since 0 normal to 3 maximal signs). All US measures of BC and RLC significantly decreased after treatment, in comparison to baseline (p < 0.001) and during the follow-up, did not change through the time (no significant difference between 2, 4, and 8 weeks). At 4 and 8 weeks, diameters measured at US are lower when BC is directly infiltrated in comparison to intra-articular injection (p < 0.01). US steroid direct injection reduces US measures and clinics of BC in knee OA, in particular, when steroid is directly infiltrated into BC.

In systemic sclerosis (SSc), the involvement of the interstitium or vascular system of the lung may lead to pulmonary arterial hypertension (PAH). PAH is often asymptomatic or oligosymptomatic in early SSc and, when it becomes symptomatic, pulmonary vascular system is already damaged. Exercise echocardiography (ex-echo), measuring pulmonary artery pressure (PAP) during exercise and allowing to differentiate physiologic from altered PAP responses, may identify subclinical PAH. Our aims were (a) to evaluate by ex-echo the change of PAP in patients with SSc without lung involvement; and (b) to correlate PAP during exercise (ex-PAP) values to clinical and biohumoral parameters of PAH. Twenty-seven patients with limited SSc (ISSc) without interstitial lung involvement were studied. Patients underwent rest and exercise two-dimensional and Doppler echocardiography by supine cycloergometer. Systolic PAP was calculated using the maximum systolic velocity of the tricuspid regurgitant jet at rest and during exercise values of systolic PAP exceeding 40 mmHg at ex-echo were considered as abnormal, and biohumoral markers potentially related to PAH were assessed. Eighteen of 27 SSc patients presented an ex-PAP > 40 mmHg, while in 9 of 27 patients ex-PAP values remained < 40 mmHg (48.8 +/- 4.5 mmHg versus 36.2 +/- 3.1 mmHg; P < 0.001). Other echocardiographic and ergometric parameters, clinical tests, and biohumoral markers were not different in the two groups. Ex-PAP significantly correlated with D-dimer (P = 0.0125; r2 = 0.2029). Ex-echo identifies a cluster of SSc patients with subclinical PAH that may develop PAH. This group should be followed up and may be considered for specific therapies to prevent disease evolution.

The real utility of high resolution computed tomography (HRCT) for early detection of lung involvement was investigated in eighteen patients affected with systemic sclerosis (SSc). The results obtained from HRCT have been compared with traditional (chest radiographs, pulmonary function tests (PFT)) and nontraditional (ventilation and perfusion scintiscan) modalities of lung investigation. A significant statistical correlation (p < 0.001) between HRCT scans and chest radiographs was observed. Moreover, HRCT was more sensitive in the detection of early pulmonary interstitial involvement and more accurate in the assessment of interstitial fibrosis in cases with severe lung involvement. A statistical correlation (P < 0.001) between HRCT and the modalities of investigation of alveolo-capillary membrane--as PFT and ventilation scintiscan--was also observed. These results indicate that in SSc HRCT may be a useful technique for assessing early pulmonary involvement and for complementing other methodologies of investigation of lung function.

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BackgroundMusculoskeletal inflammation is a frequent and debilitating feature of Systemic Lupus Erythematosus (SLE) that can involve all components of the joint, including extra-synovial sites such as the entheses1. In previous reports, enthesitis could be clearly demonstrated by musculoskeletal ultrasound (US) in small cohorts of patients with SLE2,3. However, SLE-enthesitis remains frequently overlooked and its prevalence in real-life cohorts as well as its clinical significance for disease classification and therapy remain to be determined.ObjectivesTo assess the prevalence of US-confirmed enthesitis in a monocentric cohort of patients with SLE and to analyze the clinical associations to enthesitis during the course of disease.MethodsUltrasound examinations of SLE patients presenting with tender and/or swollen joints at the Lupus Unit of the Careggi University Hospital in Florence (Italy) were retrospectively analyzed to assess the presence of enthesitis. Patients with US-proven enthesitis were compared with SLE controls who showed no US-evidence of enthesitis. Clinical features and therapies were compared between the two groups at disease onset and throughout follow-up.ResultsWe assessed 400 patients fulfilling EULAR/ACR classification criteria for SLE. In 106 of them, an US examination of the joints was performed. Evidence of enthesitis was found in 31/106 (29.2%) patients. Four participants were excluded due to lack of follow-up data. The remaining 71 patients without US-enthesitis were included as control group (Figure 1). At disease onset, all clinical features were comparable between enthesitis cases and controls. Clinical manifestations and therapy from disease onset to the last available follow-up are reported inTable 1. The median follow-up was of 10.0 (IQR 8.3-23.3) years for cases and 12.4 (IQR 7.2-13.3) years for controls. Patients with enthesitis were less likely to develop renal involvement (22.6% vs 46.5%, p<0.05), had more arthritis (100.0% vs 81.7%, p<0.01) and failed B-cell depleting therapies more frequently (75.0% vs 0%).ConclusionIn SLE patients with tender or swollen joints, enthesitis is a fairly common finding. Enthesitis in SLE could be the hallmark of a distinct disease subset with less frequent renal involvement, more arthritis, and poor response to B-cell depletion, potentially requiring alternative treatments.References[1]Dörner T,et al. Rheumatol Ther9, 781–802 (2022)[2]Di Matteo A, et al.Rheumatology57:1822–9 (2018)[3]Di Matteo A, et al.Lupus26:320–8 (2017)Table 1.Clinical and demographic characteristics.Cases of SLE with US enthesitisSLE controls without US enthesitisp-valueN3171Female, N (%)26 (83.9%)67 (94.4%)0.126Age at US-assessment, median (years) (IQR)50.0 (45.4-51.6)51.3 (43.9-59.4)0.456Disease manifestations from SLE onset to LFUMusculoskeletal, N (%)31 (100.0%)58 (81.7%)0.009*Cutaneous, N (%)23 (74.2%)44 (62.0%)0.264Hematologic, N (%)25 (80.7%)46 (64.8%)0.160Mucosal, N (%)8 (25.8%)12 (16.9%)0.416Neurological, N (%)8 (25.8%)16 (22.5%)0.801Renal, N (%)7 (22.6%)33 (46.5%)0.028*Serositic, N (%)7 (22.6%)19 (26.8%)0.806Gastrointestinal, N (%)5 (16.1%)6 (8.5%)0.302Therapy from SLE onset to LFUCorticosteroids +/- HCQ, N (%)12 (38.7%)21 (29.6%)0.369Therapy, N (%)--- MMF, N (%)7 (22.6%)18 (25.4%)1.000 MTX, N (%)6 (19.4%)15 (21.1%)1.000 AZA, N (%)6 (19.4%)11 (15.5%)0.773 CSA, N (%)4 (12.9%)4 (5.6%)0.241 CYC, N (%)4 (12.9%)4 (5.6%)0.241 RTX, N (%)8 (25.8%)12 (16.9%)0.416 Belimumab, N (%)8 (25.8%)20 (28.2%)1.000*statistically significant for p<0.05.SLE: systemic lupus erythematosus; IQR: interquartile range; SD: standard deviation; US: ultrasound; LFU: last follow-up; AZA: azathioprine; HCQ: hydroxychloroquine; MMF: mycophenolate mofetil; CCY: cyclophosphamide; CSA: cyclosporine; MTX: methotrexate; RTX: rituximab.Figure 1.Flow-chart of the patient selection processSLE: Systemic Lupus Erythematosus; US: ultrasoundDisclosure of InterestsNone declared