Spondyloarthropathies MRI now anchors spondyloarthritis diagnosis

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AUGUST 14, 2016

DENVER – MRI of the sacroiliac joint now serves as the primary imaging driver for a diagnosis of spondyloarthritis, especially early spondyloarthritis, and has largely supplanted radiographic assessment, Walter P. Maksymowych, MD, said at an educational symposium organized by the Spondyloarthritis Research and Treatment Network.

“MRI is reliable for early diagnosis; radiographic assessment of early spondyloarthritis is problematic,” said Dr. Maksymowych, a rheumatologist and professor of medicine at the University of Alberta in Edmonton. “The EULAR recommendations now say that early diagnosis of spondyloarthritis needs to focus on MRI.”

Dr. Walter P. Maksymowych
Mitchel L. Zoler/Frontline Medical News

Dr. Walter P. Maksymowych

While the recommendations from the European League Against Rheumatism (EULAR) that came out last year on using imaging for diagnosing and managing spondyloarthritis (SpA) cite radiography of the patient’s sacroiliac joint as the recommended first imaging method to use to diagnose sacroiliitis as part of a diagnosis of axial SpA, the EULAR recommendations place MRI very close behind.

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Pitfalls of Potential Lupus Diagnosis

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June 13, 2016 • By

The Rheumatologist

Spotting the signs of autoimmunity as early as possible is often viewed as a positive goal for rheumatologic research. The premise: Patients may begin treatment years before their disease is active and destroying joints and tissue.

Although much progress has been made in identifying early stages of rheumatoid arthritis pathogenesis, the clues are not as clear in systemic lupus erythematosus (SLE). Many patients who test positive for autoantibodies that could be signs of potential SLE, such as antinuclear antibodies (ANA), never actually develop the disease. Describing a patient as having potential SLE could cause unnecessary anxiety and medication prescription in these individuals, say two lupus researchers.

“Previous reports have shown that only about 20% of patients with potential SLE go on to develop definite SLE. So if we use potential SLE as a diagnosis, we would be over-treating the majority of these patients,” say Graciela S. Alarcón, MD, MPH, MACR, Jane Knight Lowe Emeritus Professor of Medicine at the University of Alabama at Birmingham, and Manuel F. Ugarte-Gil, MD, a rheumatologist at the Hospital Nacional Guillermo Almenara Irigoyen in Lima, Peru, in a joint, written response to questions from The Rheumatologist.

Unnecessary Treatment

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Osteoporosis for Patients

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This excellent information has been written by Dr. Pilar Aguado, staff member of the Rheumatology Unit at the Hospital Universitario La Paz in Madrid. Dr. Aguado is a specialist in metabolic bone pathology, and this contribution is aimed at patients. I want to express my infinite gratitude for this excellent contribution.

What is Osteoporosis?

Osteoporosis is a disease that affects all skeletal bones, and consists of a decrease in the amount and quality of bone. This makes bones lose strength, becoming more fragile, and vulnernable to easily break spontaneously or after minor injuries.

What is bone mass?

Bone mass is the amount of bone (made up of proteins and minerals, the most important being calcium) in a person’s skeleton and depends on one’s age, race, and sex. Bone mass increases from birth, as the skeleton grows until it reaches a maximum value, known as “peak bone mass”), at 30-35 years. The later the “peak,” the less chance of osteoporosis. It is, therefore important that throughout life, but especially in childhood and youth, adequate amounts of calcium are ingested. Shortly after “peak bone mass” has been reached, a physiological loss of bone will start, which, is usually slow and lasts for the rest of one’s life.

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New ACR/EULAR gout classification criteria offer better sensitivity, specificity

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By: M. ALEXANDER OTTO, Rheumatology News Digital Network SEPTEMBER 15, 2015

Rheumatology News

The presence of monosodium urate monohydrate crystals in a symptomatic joint, bursa, or tophus is sufficient to diagnose gout, according to new gout classification criteria from the American College of Rheumatology and the European League Against Rheumatism.

When symptomatic urate crystals are missing, other signs and symptoms are considered and scored; a score of 8 or more constitutes gout. “The threshold chosen for this classification criteria set yielded the best combination of sensitivity and specificity,” at 92% and 89%, respectively, and outperformed previous classification schemes, said the authors, led by Dr. Tuhina Neogi of Boston University.

Dr. Tuhina Neogi
Dr. Tuhina Neogi

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Doc, in my blood test they found the Cyclic Citrullinated Peptide Antibody (anti-CCP or ACPA) positive. Do I have Rheumatoid Arthritis?

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Sometimes, your doctor may ask for this blood test. Usually, the test is performed for people with pain/swelling joint. But on other occasions it can be done, for complaints that nothing has to do with arthritis in your joints.
We know that ACPA test has specificity for rheumatoid arthritis (RA) close to 97%. That means that people with arthritis and a positivity of this test, the probability of having RA is very high. But, what happens with people who have a positive test and they are asymptomatic?
They always ask, Doc, what are the chances to get RA? We have no answer to this question. We know that many patients with RA they have this positive test in his/her blood for many years before the disease developed. But also we know that many people with this antibody never will develop the disease. So, in case of being asymptomatic, the first question should be, why doctor you asked for this test? Did you have pain/swelling joint when the test was done? Any first-grade relative has RA? If you answer is yes to any of these questions, you need a close follow up by your rheumatologist. If this is not the case, you should ask your doctor, what was the point to inquire for this test that at this moment means nothing.

Promising New Imaging Modality for Enthesitis Whole body MRI can detect ethesitis in PsA and axSpA patients.

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Primary Source
Annals of the Rheumatic Diseases
Source Reference: Poggenborg RP, et al “Enthesitis in patients with psoriatic arthritis, axial spondyloarthritis and healthy subjects assessed by ‘head-to-toe’ whole-body MRI and clinical examination” Ann Rheum Dis 2015; DOI: 10.1136/annrheumdis-2013-204239.

Whole body magnetic resonance imaging (WBMRI), which allows assessment of all peripheral and axial joints and entheses in one examination, is a promising new imaging approach to detect enthesitis in patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), a new prospective, cross-sectional pilot study has found.

The study showed that “it is possible to detect enthesitis by “head-to-toe” WBMRI with moderate percentage agreement between MRI and clinical findings at the entheseal level”, according to Rene Penduro Poggenborg, Copenhagen Centre for Arthritis Research and Copenhagen Center for Rheumatology and Spine Diseases, Denmark, and colleagues.
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The study, published in the Annals of the Rheumatic Diseases, included 18 patients with PsA and 18 with axSpA, all with moderate to high disease activity. It also included 12 healthy controls (HS) without pain from peripheral joints or spine, family history of PsA, spondyloarthritis or rheumatoid arthritis, or personal history of psoriasis, anterior uveitis, inflammatory bowel disease, or heel pain.
Clinical enthesitis was defined as tenderness when the enthesis was palpitated with a pressure of the thumb until the tip of the nail bed blanched. Experienced clinicians examined study subjects at 18 peripheral and axial entheses at 35 different anatomical sites.
With MRI evaluations, enthesitis was defined as the presence of bone marrow edema, soft tissue edema, change in tendon thickness, erosions or enthesophytes in adjacent bones, and additional findings such as fluid around tendons or adjacent to bursa, alone or in combination.

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