It is well known that malperfusion syndrome (MPS) increases early mortality of patients suffering from acute type A aortic dissection (AADA). The aim of the present study was to analyze the outcome of patients who survived after surgical treatment of AADA with or without MPS. Data of 227 consecutive patients, who underwent surgery for AADA, were analyzed. The impact of MPS on in-hospital data and outcome was analyzed. Quality of life (QoL), using the short form 36 health survey questionnaire (SF-36), and late mortality were analyzed. Seventy-five patients (33%) with AADA had preoperative MPS. In 31 patients (41.3%), central nervous system (CNS) was involved and in 33 patients (44%) MPS of the extremities was present. Coronary malperfusion was found in 9 patients, renal in 8 patients and visceral malperfusion in 5 patients. Mean age in the group with MPS was 61.9+/-9.1 compared to 61.6+/-12.7 years without MPS (P=ns). In-hospital mortality was 18.7% in patients with MPS, compared to 9.9% without MPS (P<0.05). Follow-up revealed a significant poorer outcome in patients with MPS, with a 3-year-survival of 73.3% in patients with MPS and 86.2% without MPS (P<0.05). Average SF-36 values were lower in patients with MPS (78.3+/-12.8 vs. 87.8+/-11.9; P=ns), which is mainly due to patients with CNS-MPS, who showed an average SF-36 of 65.8+/-17.9 (P<0.05). AADA associated to MPS carries a higher early- and mid-term mortality. Postoperative mid-term QoL, however, except in patients with CNS-MPS and persistent neurological deficits, is fairly good and similar to patients who underwent successful surgery for AADA without MPS.

Long-term QoL is not permanently impaired after AAA repair, but returns in long-term survivors to what would be expected in a standard population. In this respect, differences were found neither between EVAR and OR, nor between elective and emergency repair. Perioperative mortality rates were highest in patients undergoing emergency OR. The outlook for such patients after the perioperative period, however, was similar to that for patients undergoing elective repair.

Objectives To evaluate grey scale US (GSUS) and power Doppler US synovitis (PDUS), separately or in combination (CombUS), to predict joint damage progression in RA. Methods In this cohort study nested in the Swiss RA register, all patients with sequential hand radiographs at their first US assessment were included. We analysed the summations of semi-quantitative GSUS, PDUS and CombUS assessments of both wrists and 16 finger joints (maximum 54 points) at their upper limit of normal, their 50th, 75th or 87.5th percentiles for the progression of joint damage (ΔXray). We adjusted for clinical disease activity measures at baseline, the use of biological DMARDs and other confounders. Results After a median of 35 months, 69 of 250 patients with CombUS (28%), 73 of 259 patients with PDUS (28%) and 75 of 287 patients with available GSUS data (26%) demonstrated joint damage progression. PDUS beyond upper limit of normal (1/54), GSUS and CombUS each at their 50th (9/54 and 10/54) and their 75th percentiles (14/54 and 15/54) were significantly associated with ΔXray in crude and adjusted models. In subgroup analyses, GSUS beyond 14/54 and CombUS higher than 15/54 remained significantly associated with ΔXray in patients on biological DMARDs, while clinical disease activity measures had no significant prognostic power in this subgroup. Conclusion Higher levels of GSUS and CombUS are associated with the development of erosions. GSUS appears to be an essential component of synovitis assessment and an independent predictor of joint damage progression in patients on biological DMARDs.

Current ClASsification criteria for Psoriatic ARthritis classification criteria for psoriatic arthritis (PsA) provide a preliminary definition of inflammatory articular disease. This study aimed to further characterize PsA peripheral arthritis using purely data-driven approaches for the affected joint distribution pattern. PsA patients from the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) database were clustered according to similarities in 66 swollen and in 68 tender joints. Clusters were compared in terms of other disease characteristics and studied for coincidence with traditional PsA subtypes, stability over time and treatment response upon first tumour necrosis factor alpha (TNF-α) therapy. Clustering of 957 patients resulted in an oligoarticular, a polyarticular hand dominated, a polyarticular foot dominated and a fourth cluster which was characterized by polyarticular involvement of the hands and feet. Of the traditional PsA subtypes, only a non-PsA-specific oligoarticular joint involvement pattern was retrieved by clustering. When comparing clusters in other disease manifestations, only minor and clinically probably irrelevant differences occurred. Over time, clusters were more robust than traditional PsA subtypes. Patients in different joint clusters had similar response rates upon first anti-TNF-α therapy, and minimal disease activity was achieved in 56% of 285 patients, irrespective of cluster membership. Hypothesis-free approaches to group PsA patients yield clusters with improved consistency, but without clinically important differences. Taken together, the current peripheral arthritis definition by GRAPPA without further specification into subtypes is strongly supported by the data.Electronic supplementary materialThe online version of this article (doi:10.1007/s10067-017-3637-2) contains supplementary material, which is available to authorized users.