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The results of clinical and radiological examination of 65 patients with early rheumatoid arthritis with joint syndrome duration up to 12 months were presented in the article. The incidence of radiographic erosions in conventional X-ray and magnetic resonance imaging (MRI) depending on the clinical and laboratory features was analyzed. A standard protocol of examination and a sequence of images evaluation were developed. MRI is more informative method for topical diagnosis of early arthritis compared to conventional radiography. MRI made it possible to diagnose erosive changes in the joints of 36 patients out of 65 in early rheumatoid arthritis that is significantly greater than with conventional X-ray examination (in 2 patients out of 65). Using MRI, erosive changes in the hand joints were diagnosed 12 months prior to their detection on radiograms, the most significant differences in the definition of destructive changes occur in the carpal bones and heads of metacarpal bones. The rate of wrist erosions detection on MRI correlated with seropositivity for antibodies to cyclic citrullinated peptides and did not depend on the process activity by DAS28.

Objective: to study the functional disorder, joint structural changes with acute phase parameters, and interleukin-1 beta (IL-1β) in patients with hand osteoarthritis (HOA). Materials and methods: the study included 52 women with HOA, the mean age was 63.4 (10.0) years old. The degree of functional impairment was evaluated according to the visual analogue scale (VAS) and the author’s questionnaire. The laboratory study included an assessment of ESR, C-reactive protein (CRP), and IL-1β levels in the blood. The instrumental diagnostic was performed by X-ray, ultrasonography (US), and magnetic resonance imaging (MRI) of the hand joints. Results: no significant data were obtained on the dependence of the severity of structural and functional disorders from ESR, CRP, and IL-1β levels (rConclusions: there was no correlation between HOA activity and CRP and IL-1β levels but some authors propose to use highly sensitive methods to detect CRP. The application of highly sensitive methods for CRP detection could reveal the association between this indicator and the HOA activity. The absence of dependence between IL-1β level and morpho-functional parameters agrees with the data obtained by other researchers. It is possible that the evaluation of the IL-1β level in dynamics can be useful for assessing the treatment response but this requires further studies.

Summary Objective Inflammation worsens joint destruction in osteoarthritis (OA) and aggravates pain. Saturated and n-6 fatty acids (FAs) increase, whereas n-3 FAs reduce inflammation. We examined whether FA levels affected the development of OA. Design We studied participants from the Multicenter Osteoarthritis study (MOST) at risk of developing knee OA. After baseline, repeated knee x-rays and MRIs were obtained and knee symptoms queried through 60 month follow-up. Using baseline fasting samples, serum FAs were analyzed with standard assays. After excluding participants with baseline OA, we defined two sets of cases: those developing radiographic OA and those developing symptomatic OA (knee pain and radiographic OA). Controls did not develop these outcomes. Additionally, we examined worsening of MRI cartilage loss and synovitis and of knee pain using WOMAC and evaluated the number of hand joints affected by nodules. In regression models, we tested the association of each OA outcome with levels of saturated, n-3 and n-6 FAs adjusting for age, sex, BMI, education, race, baseline pain and depressive symptoms. Results We studied 260 cases with incident symptomatic and 259 with incident radiographic OA. Mean age was 61 years (61% women). We found no signficant nor suggestive associations of FA levels with incident OA (e.g., for incident symptomatic OA, OR per s.d. increase in n-3 FA 1.00 (0.85, 1.18) nor with any OA outcome in knee or hand. Conclusion Despite previously described effects on systemic inflammation, blood levels of FAs were not associated with risk of later knee OA or other OA outcomes.

Three dimensional (3D) hand pose estimation is the task of estimating the 3D location of hand keypoints. In recent years, this task has received much research attention due to its diverse applications in human-computer interaction and virtual reality. To the best of our knowledge, there has been limited studies that model self-attention in 3D hand pose estimation despite its use in various computer vision tasks. Hence, we propose augmenting convolution with self-attention to capture long-range dependencies in a depth image. In addition, motivated by a recent work which uses anchor points set on a depth image, we extend anchor points to the depth dimension to regress 3D hand joint locations. Validation experiments using the proposed approaches are performed on various hand pose datasets, and we obtain performances that are comparable to other state-of-the-art methods. The results demonstrate the potential of these approaches in a hand-based recognition system.

The anatomy of the thumb carpometacarpal (CMC) joint, as well as the force transmitted through it, makes it extremely susceptible to osteoarthritis (OA). The thumb CMC joint has been reported as the most painful joint when compared to other hand joints affected by OA. to provide an updated, systematic review of surgical management and outcomes of the most commonly used surgical procedures to treat CMC joint OA presented in literature. we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till January, 36 studies were included. the overall effect estimates showed that the rate of pain at rest after metacarpal osteotomy was 25.1% (95% CI 9.6 – 40.7%); while the rate of satisfaction after metacarpal osteotomy was 48.1% (95% CI 10.5 – 85.7%). The overall effect estimates showed that the rate of normal handgrip after metacarpal osteotomy was 87.1% (95% CI 79.2 – 95%). the overall effect estimates showed that the rate of pain at rest after Volar ligament reconstruction was18.4% (95% CI 11.5 – 25.4%) and the rate of satisfaction was 81.6% (95% CI 74.6 – 88.5%). no surgical procedure appears to be definitely superior to another for the management of first carpometacarpal arthritis in terms of pain, physical function, patient global assessment, range of motion, or strength. Nevertheless, participants who had trapeziectomy had fewer complications than those who had the other commonly used procedures analyzed in the review.

Although visual feedback of the hand allows fast and accurate grasping actions, little is known about whether the nature of feedback of the hand affects performance. We investigated kinematics during precision grasping (with the index finger and thumb) when participants received different levels of hand feedback, with or without visual feedback of the target. Specifically, we compared performance when participants saw (1) no hand feedback; (2) only the two critical points on the index finger and thumb tips; (3) 21 points on all digit tips and hand joints; (4) 21 points connected by a “skeleton”, or (5) full feedback of the hand wearing a glove. When less hand feedback was available, participants took longer to execute the movement because they allowed more time to slow the reach and close the hand. When target feedback was unavailable, participants took longer to plan the movement and reached with higher velocity. We were particularly interested in investigating maximum grip aperture (MGA), which can reflect the margin of error that participants allow to compensate for uncertainty. A trend suggested that MGA was smallest when ample feedback was available (skeleton and full hand feedback, regardless of target feedback) and when only essential information about hand and target was provided (2-point hand feedback + target feedback) but increased when non-essential points were included (21-point feedback). These results suggest that visual feedback of the hand affects grasping performance and that, while more feedback is usually beneficial, this is not necessarily always the case.

We present an open and isolated palmar dislocation of the head of the fifth metacarpal bone without fracture. The diagnosis, which was initially made based on the X-rays, was confirmed during the operation. The patient was satisfactorily treated with open reduction, Kirschner wires fixation and casting followed with hand physiotherapy.

Introduction: Rheumatoid arthritis is a chronic, inflammatory, systemic complex disease involving joints and periarticular tissues, leading to disability and premature death. The most common and earliest locations of the inflammatory process involves hands. In addition to pharmacotherapy, therapeutic management includes physiotherapy, psychotherapy and patient education. Among the physical therapy methods, the role of laser therapy and magnetotherapy in achieving analgesic effects and improving functions is emphasized. AIM: The aim of the study was to compare the impact of low frequency magnetic field and laser therapy on pain reduction, quality of life and function improvement as well as range of motion hands joints in patients with RA. Material and Methods: The study involved 30 outpatient in the Rehabilitation Clinic of the University Clinical Hospital in Bialystok. Among all patients they were selected into two groups in which they were applied accordingly in the first group a laser stimulation and in the second group a low frequency magnetic field. There were performed 10 treatments in each group with a Saturday - Sunday break. Before and after rehabilitation was conducted a physical and subjective examination, which used: pain examination (VAS scale, Laitinen questionnaire), examination of hand range of motion and functional evaluation according to questionnaires: bMHQ, DASH, AIMS-2. Results: After used of physical therapy in both groups the results were obtained that pain was decreased. Moreover, the magnetotherapy improved the range of motion as well as the quality of life and functionality of patients measured according to the questionnaires: Laitinen, Breif MHQ, DASH, AIMS-2 more favorably than laser therapy. Conclusions: Both treatment: laser therapy and magnetotherapy provide an analgesic effect in patients with RA. It has been shown that magnetotherapy is more effective in improving hand joints mobility and patient’s quality of live.

Background Rheumatoid arthritis is a long-term autoimmune disease and inflammatory disorder. The damaging effect on cartilage, bone, ligaments, and tendons has raised the importance of the accurate diagnosis of structural damage, disease activity and severity assessment to enable therapeutic decisions and to evaluate disease outcome. US is non invasive, relatively cheap and widely accessible imaging tool that facilitates the detection of synovitis joint effusin and erosions more better than clinical, laboratory investigations alone and x-ray. Aim of the Work assess the role of of gray-scale and Doppler ultrasound early detection and characterization of synovitis and structural bone changes in wrist and hand joints in patients with Rheumatoid Arthritis by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity. Patients and Methods A cross sectional study conducted onthirty five adult patients with RA . All the patients were diagnosed according to the 2010 ACR/European League . The patients were recruited from the Rheumatology and Rehabilitation Outpatient Clinic, Faculty of Medicine, Ain Shams Hospitals .The study was approved by the ethical committee, and consents were taken from all patients enrolled in the study. Patients assessed by history taking, Clinical examination, Laboratory investigations and US gray scale and US power Doppler was done for each patient. Results This study included 35 patients with established RA, 27 females (77.1%) and 8 males (22.9%). Ranged in age between 20-70 years with mean age [45.66±12.76],the mean CDAS28 was [4.62±1.37], ESR [44.93±20.79], CRP [15.92±9.03], 33 patients (94.3%) were found to have synovial thickening, 14 patient (40%) were found to have increased vascularity by PD, joint effusion was detected in 12 patient (34.3%) particularly in MCP joints, 13 (37.1%) had bone erosion and only 9 patients (25.7%) had Tenosynovitis, most of them were detected at the extensor compartment of the wrist joint.positive correlations found between the clinical disease activity indices, laboratory investigations, duration of illness and components of the US findings. Conclusion Ultrasound is non invasive, relatively cheap and widely accessible imaging tool that facilitates the detection of synovitis and erosions,, high resolution gray scale images combined with Doppler technique have made it possible to detect slow low volume blood flow, thus improving the outcome of the standard clinical assessment in Rheumatoid synovial inflammation.

Osteoarthritis (OA) is a widespread disease accompanied by persistent joint damage with obvious functional failure, which leads to early disability in patients. In OA, different groups of joints are involved in the pathological process. Hand joints are one of the classical sites of OA. The paper discusses the role of mechanical load, genetic factors, and sex hormone deficiency in the development of the disease. The treatment policy includes a set of non-pharmacological, pharmacological, and surgical methods.

We propose a novel approach for articulated hand pose estimation from a single depth image using a very deep convolutional network. For the first, a very deep network structure is designed to directly maps a single depth image to its corresponding 3D hand joint locations. This approach eliminates the necessity of hand-crafted intermediate features and sophisticated post-processing stages for robust and accurate hand pose estimation. We use Batch Normalization to accelerate training and prevent the objective function from getting stuck in poor local minima. We introduce a low-dimensional embedding forcing the network to learn the inherent constraints of hand joints, which helps to reduce the cost of reconstructing 3D hand poses from high-dimension feature space. We discuss the effect of the convolutional network depth on its accuracy under the hand pose regression setting. Quantitative assessments on two challenging datasets show that our proposed method gets competitive results to state-of-the-art approaches in terms of accuracy. Moreover, qualitative results also show that our proposed method is robust to some difficult hand poses.

Background: Evaluation of remission in Rheumatoid Arthritis (RA) largely relies on composite scores based on clinical and laboratory assessments however, patients can fulfill clinical remission criteria as defined by composite scores, yet still have evidence of synovitis detectable on imaging. Aim of the work: To evaluate hand and wrist joints in patients with RA in clinical remission using power Doppler (PD) ultrasonography and to study the association between ultrasonographic findings and composite index scores. Patients and methods: This study was conducted on 50 RA patients in clinical remission. Ten matched healthy subjects were included as control. The modified health assessment questionnaire (MHAQ) was assessed in the patients; disease activity was calculated using a composite index score including disease activity score (DAS28) and clinical disease activity index (CDAI). Ultrasonographic assessment of the hand and wrist joints was performed. Results: The mean age of the patients was 50.9 ± 9.2 years, disease duration was 10.6 ± 5.5 years and were 38 females and 12 males. The mean DAS28 was 2.3 ± 0.3. On ultrasonographic examination, 14 (28%) patients had normal synovium, while 18 (36%) showed synovial hypertrophy without evidence of inflammation and 18 (36%) had PD signals. DAS28 was higher in patients with PD signals (2.36 ± 0.3) compared to those without synovitis (2.3 ± 0.28). There was a significant correlation between PD activity and CDAI (p = 0.005), MHAQ (p = 0.002) and disease duration (p = 0.023). Conclusion: Power Doppler ultrasound can detect residual inflammation in RA patients in clinical remission and its scores were signficantly associated with the clinical disease activity index and functional status. Keywords: Rheumatoid arthritis, Remission, Disease activity score-28 (DAS28), Clinical Disease Activity Index (CDAI), Power Doppler ultrasonography

To evaluate the efficacy and safety of using the drug Voltaren Emulgel 2% (diclofenac diethylaminе 2%) for 14 days in patients with osteoarthritis (OA) of small joints of the hands.62 patients of both sexes with hands OA were included in the study, 31 of whom (main group) used Voltaren Emulgel 2% (diclofenac diethylaminе 2%) topically, and the remaining 31 (comparison group) Voltaren Emulgel 2% (diclofenac diethylamine 2%) + oral nonsteroidal anti-inflammatory drugs. The effectiveness of therapy was assessed by using a visual analogue scale (VAS) in dynamics: joint pain and stiffness at rest, pain on movement and during palpation, by functional indices AUSCAN, FIHOA, by assessment of the effect of therapy by the doctor and the patient on a weekly basis.Joint pain decreased after 2 weeks of therapy in all patients during treatment with Voltaren Emulgel 2% (diclofenac diethylamine 2%) in both groups. Significant reduction in stiffness and improvement in hand joint function was achieved after 7 days and lasted until the end of treatment. By the end of treatment, 100% of patients assessed their condition as improvement.Voltaren Emulgel 2% (diclofenac diethylamine 2%) demonstrates comparable clinical efficacy in patients with OA of the hand joints (reduced pain, stiffness and improved joint function) in monotherapy as complex therapy in combination with oral NSAIDS, while being well tolerated.Цель. Оценить эффективность и безопасность применения препарата Вольтарен Эмульгель 2% (диклофенака диэтиламин 2%) в течение 14 дней у пациентов с остеоартритом (ОА) мелких суставов кистей. Материалы и методы. В исследование включены 62 пациента обоего пола с ОА мелких суставов кистей, из которых 31 человек (основная группа) использовал Вольтарен Эмульгель 2% (диклофенака диэтиламин 2%) местно и 31 (группа сравнения) пероральные нестероидные противовоспалительные препараты (НПВП) + Вольтарен Эмульгель 2% (диклофенака диэтиламин 2%). Эффективность терапии оценивалась с использованием визуальной аналоговой шкалы в динамике по показателям суставной боли и скованности в состоянии покоя и при движении, с применением функциональных индексов AUSCAN, FIHOA, учитывалась оценка эффекта от проводимой терапии врачом и пациентом еженедельно. Результаты и обсуждение. Боль в суставах уменьшилась через 2 нед терапии у всех больных в обеих группах на фоне лечения препаратом Вольтарен Эмульгель 2% (диклофенака диэтиламин 2%). Достоверное уменьшение скованности и улучшение функции суставов кистей достигнуто через 7 дней и сохранялось до конца лечения. Все (100%) больные ОА мелких суставов кистей оценили свое состояние как улучшение к концу лечения. Заключение. Вольтарен Эмульгель (диклофенака диэтиламин 2%) продемонстрировал сопоставимую клиническую эффективность в лечении ОА суставов кистей (уменьшение боли, скованности и улучшение функции суставов) в монотерапии, с таковой для комплексной терапии в комбинации с пероральными формами НПВП, обладая при этом хорошей переносимостью.

Tendon has excellent sliding mechanism and functions as the transmission for the hand joint movement. Tendon injury will cause severe hand movement dysfunction. In order to restore the functions of limbs and fingers, ruptured or deficient tendons must be repaired in time. Commonly used tendon repair methods include modified Kessler stitching, Bunnell stitching, Tsuge loop stitching, etc. After tendon repair, the major issue is to prevent either tendon adhesion or tendon re-rupture. Therefore, tendon surgery should achieve non-invasive suturing repair. The suturing material should cause less damage to the tendon tissue, and have good tensile strength, so that it could meet the requirements of postoperative rehabilitation training for patients, so as to reduce tendon adhesion and re-rupture. In early postoperative rehabilitation, it is advisable for patients to do active-passive combined exercise or active exercise as primary and passive as supplement, so as to maximize the restoration of the function of each hand joint.

The hand and wrist is a complex anatomical area and is frequently affected by rheumatological diseases. Routine radiography is crucial to evaluate and diagnose many diseases affecting the hand and wrist and usually complements ultrasound examinations especially in assessing structural bony changes such as erosions and osteophytes and crystal deposition. Ultrasound has a valuable role in the assessment of the wrist and hand joints including tendons, ligaments and nerves which may be affected by inflammatory rheumatological diseases and is an important tool in the early diagnosis and subsequent management of rheumatological disease. In this chapter, we will focus on the most relevant areas in the wrist and hand that are affected by rheumatological diseases and offer a systematic approach to a comprehensive and thorough examination of this joint in order to accurately assess for any underlying disease pathology. We also discuss the relevant anatomy, an understanding of which is essential to perform accurate ultrasound. The wrist and hand examination is carried out by an examination of the dorsal and volar wrist followed by the dorsal hand and then volar hand. A careful examination of the medial and lateral aspects is carried out to identify bony erosions (especially of the MCPJs) and other structural changes such as tenosynovitis of the 1st extensor (APL/EPB) and 6th extensor tendon (ECU tendons) and disease of triangular fibrocartilage (such as crystal deposition).

No difference between both hands was observed for clinical and radiographical presentations in EHOA patients. A bilateral and symmetrical relationship was found between hand joints. EHOA have symmetrical distribution and specific association in structural lesions. This study aims to analyse the preferential topographical distribution of clinical and structural lesions between the dominant and non-dominant hands in erosive hand osteoarthritis (EHOA) patients. Both hands were assessed via radiography in EHOA patients. A comparative analysis of the clinical features and structural lesions between the dominant and non-dominant hands was performed. The structural lesions were assessed according to the anatomical radiographic score of Verbruggen-Veys (VV). Next, a principal component analysis was performed to describe and highlight the relationships observed between the joints. Sixty patients were included in this study: there were 57 women, and the mean age was 66.1 (± 7.6) years. For the distal interphalangeal (DIP) joints, nodes were observed more frequently on the dominant hand (4 vs 3; p = 0.005). No difference in structural lesions was observed between the two hands except for the 2nd proximal interphalangeal (PIP) (p = 0.045). A principal component analysis with varimax rotation described relationships between the 2nd PIP, 3rd PIP, 4th PIP, 4th DIP and 5th DIP joints in both hands. No significant differences between dominant and non-dominant hands were observed for clinical and structural lesions in our sample of EHOA patients. A bilateral and symmetrical injury was observed in most EHOA joints. Trial registration Clinical trial registration number: NCT01068405.

As we use our hands frequently in daily activities, the analysis of hand-object interactions plays a critical role to many multimedia understanding and interaction applications. Different from conventional 3D hand-only and object-only pose estimation, estimating 3D hand-object pose is more challenging due to the mutual occlusions between hand and object, as well as the physical constraints between them. To overcome these issues, we propose to fully utilize the structural correlations among hand joints and object corners in order to obtain more reliable poses. Our work is inspired by structured output learning models in sequence transduction field like Transformer encoder-decoder framework. Besides modeling inherent dependencies from extracted 2D hand-object pose, our proposed Hand-Object Transformer Network (HOT-Net) also captures the structural correlations among 3D hand joints and object corners. Similar to Transformer's autoregressive decoder, by considering structured output patterns, this helps better constrain the output space and leads to more robust pose estimation. However, different from Transformer's sequential modeling mechanism, HOT-Net adopts a novel non-autoregressive decoding strategy for 3D hand-object pose estimation. Specifically, our model removes the Transformer's dependence on previously generated results and explicitly feeds a reference 3D hand-object pose into the decoding process to provide equivalent target pose patterns for parallely localizing each 3D keypoint. To further improve physical validity of estimated hand pose, besides anatomical constraints, we propose a cooperative pose constraint, aiming to enable the hand pose to cooperate with hand shape, to generate hand mesh. We demonstrate real-time speed and state-of-the-art performance on benchmark hand-object datasets for both 3D hand and object poses.

Recently, understanding hand and object manipulation is an active topic in First-Person Vision (FPV) community. In this study, we present an initial study on estimating 3-D hand joints using the state-of-the-art neuronal network. We firstly propose a pre-processing step that is to separate hand regions from clustered background. We deploy the completed pipeline for estimating 3-D hand joints based on HandPointNet (HPN). HPN demonstrates the state-of-the-art hand pose estimation performances with depth data. We deploy a fine-tuning scheme to Hand PointNet (HPN) on the CVAR [1], UCI-EGO [2] datasets for 3D hand pose estimation. In the experimental results, we evaluate the estimated results using the pre-processing step to see the effectiveness of the proposed method. The results show that 3-D joint estimation errors are decreased comparing with the full hand data on different datasets as MSRA, NYU, ICVL. Particularly, we measure the estimation errors of missing, obscured data. The experimental results infer that, it is still existing a big gap between the results of un-occluded and occluded cases. Based on this initial study, we tend to investigate more deeply the techniques addressing the object occlusions or self-occlusions cases that make the current networks hard to localize hidden joints/parts of the hand.

Background: ImageJ software is used to quantify the joint space width (JSW) of hand and wrist in patients with rheumatoid arthritis (RA) as well as in the healthy control group. Method: Forty-one RA patients and 31 healthy controls were included in this study. All of 72 participants underwent digital radiography of the bilateral hand and wrist; then, all the images were opened by ImageJ software to measure the width of wrist and hand joint space (total 2160 joints). Joint space narrowing (JSN) was defined if the width was less than the mean - 2SD of the control group. Result: The mean JSW of all sites of wrist and hand joints of RA patients were significantly reduced as compared to those in the control group (p Conclusion: ImageJ software is simple and convenient that helps rheumatologists quantify the width of joint space for diagnosis and follow-up in RA patients.

Knuckle pads or Garrod’s nodes are a rare, non-inflammatory condition. They consist of benign, well-circumscribed fibro-adipose tissue over the small joints of hands and feet. Knuckle pads may be under-diagnosed and mistaken for early arthritis. The rheumatologist should perform an accurate differential diagnosis in which he can be helped by ultrasound and by other colleagues, such as the dermatologist. Ultrasound is considered useful in the assessment of the thickening of the subcutaneous tissue, located usually on the extensor site of proximal interphalangeal and metacarpophalangeal hand joints. Dermoscopy may play a role in detecting epidermal and dermal changes. We hereby report the case of a female patient with knuckle pads mimicking psoriatic arthritis.

Several studies have evaluated the association between serum adiponectin levels and knee and hand osteoarthritis (OA); mixed results have been reported. We investigated the relationship between OA and serum adiponectin levels according to the radiographic features of knee and hand OA. A total of 2402 subjects was recruited from the Dong-gu Study. Baseline characteristics were collected via a questionnaire, and X-rays of knee and hand joints were scored using a semi-quantitative grading system. The relationship between serum adiponectin levels and radiographic severity was evaluated by linear and logistic regression analysis. Subjects in the higher serum adiponectin levels tertiles were older and had a lower body mass index (BMI) than those in the lower tertiles. Regarding knee joint scores, serum adiponectin levels was positively associated with the total (P

International audience; The knowledge of local stress distribution in hand joints is crucial to understand injuries and osteoarthritis occurrence. However, determining cartilage contact stresses remains a challenge, requiring numerical models including both accurate anatomical components and realistic tendon force actuation. Contact forces in finger joints have frequently been calculated but little data is available on joint contact pressures. This study aimed to develop and assess a hybrid biomechanical model of the index finger to estimate in-vivo joint contact pressure during a static maximal strength pinch grip task. A finite element model including bones, cartilage, tendons, and ligaments was developed, with tendon force transmission based on a tendon-pulley system. This model was driven by realistic tendon forces estimated from a musculoskeletal model and motion capture data for six subjects. The hybrid model outputs agreed well with the experimental measurement of fingertip forces and literature data on the physiological distribution of tendon forces through the index finger. Mean contact pressures were 6.9 ± 2.7MPa, 6.2 ± 1.0 MPa and 7.2 ± 1.3MPa for distal, proximal interphalangeal and metacarpophalangeal joints, respectively. Two subjects had higher mean contact pressure in the distal joint than in the other two joints, suggesting a mechanical cause for the prevalence of osteoarthritis in the index distal joint. The inter-subject variability in joint contact pressure could be explained by different neuromuscular strategies employed for the task. This first application of an effective hybrid model to the index finger is promising for estimating hand joint stresses under daily grip tasks and simulating surgical procedures.

Background: Several studies have evaluated the association between the serum adiponectin level and knee and hand osteoarthritis (OA); mixed results have been reported. We investigated the relationship between OA and the serum adiponectin level according to the radiographic features of knee and hand OA.Methods: A total of 2,402 subjects was recruited from the Dong-gu Study. Baseline characteristics were collected via a questionnaire, and X-rays of knee and hand joints were scored using a semi-quantitative grading system. The relationship between the serum adiponectin level and radiographic severity was evaluated by linear regression analysis.Results: Subjects in the higher serum adiponectin level tertiles were older and had a lower body mass index (BMI) than those in the lower tertiles. Regarding knee joint scores, the serum adiponectin level was positively associated with the total score (P < 0.001), osteophyte score (P = 0.003), and joint space narrowing (JSN) score (P < 0.001) after adjustment for age, gender, BMI, smoking, alcohol consumption, education, and physical activity. In terms of hand joint scores, no association was found between the serum adiponectin level and the total score, osteophyte score, JSN score, subchondral cyst score, sclerosis score, erosion score, or malalignment score after the above-mentioned adjustments.Conclusion: An increased serum adiponectin level was associated with a higher radiographic score in the knee joint, but not in the hand joint, suggesting the involvement of different pathophysiologic mechanisms in the development of OA between those joints.

BACKGROUND: It is important to quantitatively assess tremor for accurate diagnosis and evaluation of the response to interventions in patients with essential tremor (ET). OBJECTIVE: The purpose of this study was to investigate the relationship between quantitative measures of postural tremor and clinical rating scale in patients with ET. METHODS: 18 ET patients performed a postural tremor task that required them to hold their arms outstretched parallel to the floor while wearing a gyro sensor based measurement system. The time domain variables were derived from the sensor signals. Additionally, the frequency domain variables were derived from the power spectrum of the angular velocity signal. Spearman correlation analysis was employed in the relationship between the variables and clinical score. RESULTS: The RMS angular velocity of roll and yaw directions at the hand joint were strongly correlated with the clinical rating scale (r= 0.7, p< 0.01). Similarly, the peak power of roll and yaw directions at the hand joint were moderately correlated with the clinical rating scale (r= 0.61 and r= 0.67, p< 0.01). In contrast, no significant correlation coefficients were observed in the peak frequency (p> 0.05). CONCLUSION: These results indicate that hand tremor of roll and yaw directions are more associated with assessment of severity of ET compared to other joints. This study suggests that quantitative measurements of postural tremor should be considered as tremor directionality as well as attachment location.

Background It has been well documented that patients with symptoms of RA often wait for a long time before consulting their GP. This delay is one of the main reasons why only a minority of RA patients are treated within the 3-month therapeutic window of opportunity. In previous research we have shown that people often do not perceive the initial symptoms of RA to be serious or worthy of urgent medical attention. 40% of respondents to a large-scale survey said they would visit a pharmacy for advice before or instead of visiting a GP following the onset of RA symptoms. Therefore, pharmacy staff appear to be well placed to signpost patients with suspect symptoms towards GP consultation. The current research explores the knowledge and perceptions of RA in a range of pharmacy staff and their views on identifying patients with inflammatory symptoms who would benefit from a GP consultation. This information could identify training needs and opportunities for positive intervention. Methods We conducted semi-structured qualitative interviews (face to face or by telephone) with pharmacy staff. Audio recordings of the interviews were transcribed, and the data were analysed by thematic analysis facilitated by NVIVO. Results A total of 19 pharmacy staff (10 males, 9 females) aged between 22 and 56 were interviewed. Interviewees had a variety of roles within the pharmacy including pharmacist or preregistration pharmacist and pharmacy assistants. Interviewees worked at either a (small) chain pharmacy or an independent pharmacy. Accurate knowledge of RA, the seriousness of the disease and knowledge of the importance of early treatment varied greatly amongst staff impacting on their advice given to patients. Further, although many pharmacy staff said they would suggest a GP visit if someone presented with joint swelling, pain and stiffness, others would advise self-management first and only suggest a GP visit if symptoms did not improve. Pharmacy staff indicated that although they felt that they were ideally placed to signpost people to appropriate care, there was a need for additional training (e.g. on how to identify synovial swelling on inspection of the hand joints) in order for them to distinguish the symptoms of inflammatory arthritis from those of non-inflammatory conditions and suggest appropriate care. Conclusion These interviews suggest that although some pharmacy staff already play a role in accurately signposting people with RA towards a GP visit others need further training. This training should enable them to confidently recognise the symptoms signs of RA and other Musculoskeletal conditions and understand that RA is a serious condition that needs rapid disease modifying treatment initiation and consequently that people need to see their GP promptly. Disclosures G. Simons None. G. Mahoney None. N. Wyatt None. R.J. Stack None. K. Raza Grants/research support; KR has received speaker fees/ honoraria from Abbvie, Sanofi, Lilly, UCB, BMS, Pfizer, Janssen and research grant funding from Pfizer Inc. M. Falahee None.

While scarring in general can prove difficult to treat satisfactorily for physicians, specific locations of scarring can make this task even more difficult. Scarring on the scalp can result in alopecia which, especially in women and children, can be extremely stigmatizing. On the face and chest, scars lead to severe aesthetic impairments and commonly result in significantly reduced quality of life. If the hands, feet, or large joints are affected by severe scarring, functional problems can arise that, if most severe, put their self-reliance throughout their daily lives at risk. Therefore, finding solutions for such scarring is imperative.Finding the right technique to address a specific scar requires analysis of the problem. If scars are contracted, scar releases through local flaps (Z-plasty, W-plasty, and others) are common procedures. In widespread instable scars, large areas of tissue can be replaced by dermal substitutes and split-thickness skin grafting and full-thickness skin grafting or through the use of free tissue flaps. Additionally, fractional lasers provide the opportunity to soften scarred skin and to ameliorate the often irregular surface texture of such scars. For the treatment of problematic areas, combining different treatment options with regard to the individual requirements of the scar will commonly yield satisfactory results. Care should be taken to incorporate physiotherapy, occupational therapy, and conservative scar treatment paradigms to prevent future scarring in treated areas and to improve and conserve the reconstituted function in scarred areas.

Background: Lichen planus is a skin disease that may last for years, mainly affecting the skin surface and mucous membranes (such as the oral and genital mucosa), and more rarely, on the nails and hairs. Systemic acitretin is an effective therapeutic agent used in the treatment of lichen planus. The skeletal toxicity of retinoids is controversial. Because skeletal toxicity cannot be demonstrated with acitretin, radiological monitoring is not recommended. Case Report: A 24-year-old male patient was admitted to our dermatology outpatient clinic with hand metacarpophalangeal, proximal interphalangeal joint swelling, and pain, who was in the third month of systemic acitretin treatment for oral lichen planus. In our case, another cause of etiologic could not be detected, and arthritis due to acitretin was considered. Conclusion: As a result, it should not be forgotten that acute arthritis may rarely occur during the use of acitretin and should not be overlooked by the clinician

In this paper, we investigate the benefit of 3D hand skeletal information to the task of sign language (SL) recognition from RGB videos, within a state-of-the-art, multiple-stream, deep-learning recognition system. As most SL datasets are available in traditional RGB-only video lacking depth information, we propose to infer 3D coordinates of the hand joints from RGB data via a powerful architecture that has been primarily introduced in the literature for the task of 3D human pose estimation. We then fuse these estimates with additional SL informative streams, namely 2D skeletal data, as well as convolutional neural network-based hand- and mouth-region representations, and employ an attention-based encoder-decoder for recognition. We evaluate our proposed approach on a corpus of isolated signs of Greek SL and a dataset of continuous finger-spelling in American SL, reporting significant gains by the inclusion of 3D hand pose information, while also outperforming the state-of-the-art on both databases. Further, we evaluate the 3D hand pose estimation technique as standalone.

Objective.We aimed to determine whether hand joints develop an accelerated form of osteoarthritis (OA) and to characterize individuals who develop accelerated hand osteoarthritis (AHOA).Methods.We evaluated 3519 participants in the Osteoarthritis Initiative with complete data for baseline and 48-month radiographic hand osteoarthritis (HOA). One reader scored posteroanterior radiographs of the dominant hand using a modified Kellgren-Lawrence (KL) scale and another reader scored the presence of central or marginal erosions. A third reader read images flagged for signs of diseases other than OA. We defined AHOA as ≥ 1 joints that progressed from a KL grade of 0 or 1 at baseline to KL grade 3 or 4 at 48 months.Results.The definition of AHOA was met by 1% over 4 years: 37 hands had 1 joint affected and 1 hand had 2 joints affected. At baseline, adults who developed AHOA were more likely to have hand pain (37% vs 22%), radiographic HOA (71% vs 36%), as well as central (22% vs 7%) and marginal erosions (11% vs 2%) in other joints compared to those without AHOA. Adults with AHOA were more likely to develop new erosions over 48 months (central 35%, marginal 5%) than those without AHOA (central 5%, marginal 1%). The most common locations of accelerated OA were the second metacarpophalangeal and first carpometacarpal joint.Conclusion.Accelerated OA can occur in the hand, especially among digits commonly used for pinching and fine motor skills.

The present study estimated instantaneous hand joint centers of rotation (CoR) using 3D reconstructed hand skeleton motions captured from CT scan. We proposed a novel method for estimation of instantaneous joint CoR using the same bone surfaces for different hand postures. Each bone in a template hand posture was registered to the corresponding bone of different hand postures. The registered hand postures (having the same bone surfaces as the template hand posture but different postures) with the template hand posture were then used for estimation of instantaneous joint CoR. The proposed method performed better than the existing methods in estimation of instantaneous joint CoR. Consistency of instantaneous joint CoRs determined in the same rotation angle range was improved by 31.7% to 51.0% in the proposed method. The present study focused on distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints of the index finger of a participant. Joints of the whole hands of more participants will be studied for further generalization of the findings.

The utility of superb microvascular imaging (SMI) for evaluating hand joint lesions in patients with rheumatoid arthritis (RA) in clinical remission is unreported. This study aimed to compare SMI and power Doppler imaging (PDI) for the evaluation of hand joint lesions in these patients. Twenty-six patients with RA in clinical remission were enrolled. A total of 572 joints (52 wrist, 260 proximal interphalangeal, and 260 metacarpophalangeal joints) were detected by SMI and PDI. A semi-quantitative scale of 0-3 was used to compare the detection of synovial blood flow signal by SMI and PDI. Inter-observer agreement for the assessment of SMI and PDI scores was measured with kappa values. In the ten healthy volunteers, SMI and PDI signals were both scored 0. In the 26 RA patients, the remission rate via PDI was 65.4% but was only 42.3% via SMI. SMI also detected microvessel flow signal in seven patients diagnosed with clinical remission via PDI. Moreover, a total of 106 blood flow signals (18.5%) were detected by SMI, while 50 blood flow signals (8.7%) were detected by PDI. Compared with PDI, SMI increased 18.0% of power flow signals from Grade 0-1 and increased 13.7% of power flow signals from Grade 1-2. One joint classified as Grade 1 by PDI was classified as Grade 0 by SMI. Inter-observer agreement for PDI and SMI semi-quantitative scoring was moderate (kappa = 0.463). SMI seems more sensitive than PDI for detecting hand joint lesions in RA in clinical remission PDI, and could aid the achievement of true remission in RA patients.

Background: Rheumatoid arthritis (RA) is an inflammatory rheumatic disease with progressive course affecting articular and extra-articular structures resulting in pain, disability and mortality. Persistent inflammation leads to erosive joint damage and functional impairment in the vast majority of patients. The onset of disease is not similar in all patients but varies in regard to type, number, and the pattern of joint involvement. The course of disease may be also different according to the presence or absence of several variables including genetic background, frequency of swollen joints, autoantibody in the serum and the severity of inflammatory process. Objective: The aim of this study was to demonstrate the role of Ultrasonography and Power Doppler in diagnosis of activity of rheumatoid arthritis in the hands and wrist joints among different aged population, compared with the laboratory investigations. Patients and Methods: This study was carried out in Radiology department of Ain Shams university hospitals. Twenty-five patients known patients with rheumatoid arthritis suspecting activity will underwent assessment by ultrasonography and power Doppler of both wrist and hand joints. Result: US & PD are highly sensitive and specific in detection of activity of the Rheumatoid Arthritis in correlation to laboratory investigations. So, they can be used as non-invasive methods in detection of RA activity changes in wrist and hand joints. Conclusion: Both ultrasonography and power doppler are good predicators for activity in rheumatoid arthritis patients

Due to the development of synovitis, early-stage hand osteoarthritis (HOA) mimics hand joint injury in rheumatoid arthritis (RA). However, the topography of synovitis is diverse in these diseases: distal interphalangeal and thumb joints are involved in the process in HOA. In the latter, tests are negative for immunological markers (anti-cyclic citrullinated peptide antibodies), which is typical of RA. The differences between HOA and RA are prominent, as evidenced by hand X-rays and magnetic resonance imaging. Investigations suggest that cytokine profile imbalance is implicated in the pathogenesis of osteoarthritis, which brings it closer to RA. However, therapy for HOA has not been practically developed; there are only a few works on the use of disease-modifying antirheumatic drugs and biological agents in these patients. It is necessary to work out Russian guidelines for the treatment of HOA.

This is the first study to investigate the usefulness of a standardized ultrasound (US) examination protocol in diagnosing hand osteoarthritis (OA). We conducted a cross-sectional study including 62 patients, ultimately diagnosed with hand OA based on imaging evidence of osteoarthritic changes with the particular distribution required for fulfilment of American College of Radiology diagnosis criteria. We compared a 32-joint US score (wrists, metacarpophalangeal [MCP], proximal interphalangeal [PIP] or distal interphalangeal [DIP] and carpometacarpal [CMC]-1 joints), with smaller, predefined joint scores, assessing 22 joints (wrists, MCPs and PIPs or PIPs, DIPs and CMC-1), 10 joints (MCP 2-3, PIP 2-3 and CMC-1 or PIP 2-3, DIP 2-3 and CMC-1) and 6 joints (DIP 2-3, CMC-1), respectively. The US findings were correlated with radiographic scores for erosions and osteophytes. Radiographic osteophyte scores correlated well with all the US scores mentioned earlier (R = 0.381 to 0.645, p 0.05), despite low sensitivity for detection of osteophytes (43.5%) and erosions (28.9%), compared with the 32 joint US score. Both 10 joint US protocols (assessing MCP 2-3, PIP 2-3 and CMC-1 or PIP 2-3, DIP 2-3 and CMC-1 joints) performed better than conventional radiography, by identifying osteophytes in an additional 25.6% and 23.9% of patients, respectively. The conclusion of this study is that the US examination of 10 preselected hand joints is more sensitive than conventional radiography in diagnosing hand OA in patients who do not fulfill American College of Radiology clinical criteria, a finding likely to have practical implications for facilitating diagnosis of hand OA.

Objective: To investigate the association of high baseline serum levels of metalloproteinases-3 (MMP-3) with structural damage to hand and feet joints, assessed by ultrasonography (US), in patients with early, treatment-naïve rheumatoid arthritis (RA), without initial X-ray-visible erosions, during 24 months follow-up. Methods: Sixty-three early RA (European League Against Rheumatism/American College of Rheumatology 2010), disease-modifying anti-rheumatic drugs/glucocorticoid naïve patients (mean age 53.4 ± 14.1) with symptom duration ≤12 months, had baseline serum levels of MMP-3 tested. OMERACT US group definition was used to detect the presence, as well as longitudinal diameter of erosions by US at study entry and after 24 months, at the level of wrists, metacarpophalangeal (MCP2/MCP5) joints of both hands, and fifth metatarsophalangeal joints. Results: Complete data were collected from 52 out of 63 patients. High baseline serum levels of MMP-3 (MMP-3-positive) were found in 46/63 patients. 122 bone erosions in total (1.9 bone erosions/patients) were detected by US at baseline visit and 213 erosions (4.3/patients) after 24 months. MMP-3 positive patients had significantly higher total number of erosions than MMP-3-negative (p = 0.039) and higher increase in size of bone erosions in the feet but not in the hand joints after follow-up (OR 4.82 [1.23–18.9], p = 0.024; OR 1.17 [0.320–4.26], p = 0.816 respectively). Conclusion: After 2 years of follow-up, US assessment showed a higher number of new bone erosions in MMP-3-positive compared to MMP-3-negative patients with early RA and no visible initial radiographic changes. High baseline levels of MMP-3 predict significantly higher structural damage progression at the level of feet, but not at the level of hand joints.

A 30-year-old woman with esophageal squamous cell carcinoma experienced joint pain and swelling in bilateral knees, wrists, and hand joints during the course of neoadjuvant immunochemotherapy. She underwent 18F-FDG and 68Ga-FAPI PET/CT for response assessment of the tumor and evaluating her arthritis. 68Ga-FAPI PET/CT detected intense uptake in multiple joints, consistent with her polyarthritis. However, these joints showed only mild FDG uptake. The tumor was in complete response, and her polyarthritis was considered as inflammatory arthritis induced by anti-PD1.

To update our earlier systematic reviews which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not evaluated.RCTs published between March 2008 and December 2015 were added to the previous systematic reviews.A total of 95 RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this update. Generally, the methodological quality of these RCTs has improved since the last update, with more studies describing their methods for randomization, blinding, and allocation concealment. However, RCTs continue to be weakened by a lack of consistent case definition and a lack of standardized outcome assessments specific to hand OA. The number and location of evaluated hand joints continues to be underreported, and only 25% of RCTs adequately described the method used to ensure allocation concealment. These remain major weaknesses of published RCTs. A meta-analysis could not be performed because of marked study heterogeneity, insufficient statistical data available in the published RCTs, and a small number of identical comparators.Hand OA is a complex area in which to study the efficacy of therapies. There has been an improvement in the overall design and conduct of RCTs, however, additional large RCTs with a more robust methodological approach specific to hand OA are needed in order to make clinically relevant conclusions about the efficacy of the diverse treatment options available.

Background It is not known, whether outcome reporting in trials of total joint arthroplasty in the recent years is adequate or not. Our objective was to assess whether outcomes reported in total joint replacement (TJR) trials fulfil the Outcome Measures in Rheumatology (OMERACT) Filter 2.0. Methods We systematically reviewed all TJR trials in adults, published in English in 2008 or 2013. Searches were conducted in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Two authors independently applied the inclusion criteria for the studies, and any disagreement was resolved with a third review author. All outcome measures were abstracted using a pre-piloted standardised data extraction form and assessed for whether they mapped to one of the three OMERACT Filter 2.0 core areas: pathophysiological, life impact, and death. Results From 1635 trials identified, we included 70 trials (30 in 2008 and 40 in 2013) meeting the eligibility criteria. Twenty-two (31%) trials reported the three essential OMERACT core areas. Among the 27 hip replacement surgery trials and 39 knee replacement surgery trials included, 11 hip (41%) and nine knee (23%) trials reported all three essential OMERACT core areas. The most common outcome domains/measures were pain (20/27, 74%) and function (23/27, 85%) in hip trials and pain (26/39, 67%) and function (27/39, 69%) in knee trials. Results were similar for shoulder and hand joint replacement trials. Conclusions We identified significant gaps in the measurement of OMERACT core outcome areas in TJR trials, despite the majority reporting outcome domains of pain and function. An international consensus of key stakeholders is needed to develop a core domain set for reporting of TJR trials. Systematic review registration PROSPERO CRD42014009216 Electronic supplementary material The online version of this article (doi:10.1186/s13643-017-0498-3) contains supplementary material, which is available to authorized users.

The aim of this study was to identify the prevalence and distribution of sesamoid bones in the hand using digital tomosynthesis (DTS) in comparison to previous studies. Using conventional radiography (CR) and DTS, hand images (81 left and 100 right) taken at a tertiary hospital were retrospectively reviewed. The sesamoid bones were identified in the interphalangeal (IP) and metacarpophalangeal (MCP) joints of the thumb (I), and in the distal interphalangeal (DIP) and metacarpophalangeal (MCP) of index (II), middle (III), ring (IV), and little (V) fingers. Differences in number of sesamoid bones detected on CR and DTS were analyzed. Sesamoid bones were observed in MCP I (100%), MCP II (46%), MCP III (2%), MCP IV (2%), MCP V (53%), and IP I (53%) on CR. Using DTS, sesamoid bones were found more often in MCP I (100%), MCP II (54%), MCP III (2%), MCP IV (1%), MCP V (59%), and IP I (75%). Differences in the mean number of sesamoid bones detected on CR and DTS were statistically significant. Sesamoid bones in DIP joints were frequently observed on DTS, but rarely found on CR. Most sesamoid bones in the hand were detected in MCP I, II, V, and IP I joints, and were more often detected on DTS than CR. DTS is a reliable tool to evaluate bony structures in the hand. Clin. Anat. 30:608-613, 2017. © 2017 Wiley Periodicals, Inc.

To explore whether smoking and alcohol use are associated with hand osteoarthritis (OA) features in two different OA cohorts.We studied 530 people with radiographic hand OA from the Musculoskeletal pain in Ullensaker STudy (MUST) and 187 people from the Oslo hand OA cohort [mean (sd) age 65 (8.0) and 62 (5.7) years, 71% and 91% women, respectively]. Smoking, alcohol use and hand pain were self-reported. Participants underwent conventional hand radiographs and ultrasound examination of 30 hand joints. The Kellgren-Lawrence sum score for radiographic OA severity (0-120 scale) and the proportion of participants having at least one joint with grey-scale synovitis (grade ≥1) were calculated. We studied whether smoking and alcohol use were cross-sectionally associated with radiographic OA, synovitis, and pain using adjusted linear and logistic regression analyses.Smoking was associated with less radiographic OA in both cohorts [β = -4.71, 95% confidence interval (CI) -8.36 to -1.06 for current smoking in MUST and β = -0.15, 95% CI -0.29 to -0.02 for smoking pack-years in the Oslo hand OA cohort]. Stratified analyses indicated that the association was present in men only. Being a monthly drinker (examined in MUST only) was significantly associated with present synovitis compared to never drinkers (odds ratio = 2.35, 95% CI 1.27 to 4.34) (no gender differences). Neither smoking nor alcohol was associated with hand pain.Smoking was associated with less radiographic hand OA whereas alcohol consumption was associated with present joint inflammation in hand OA. Future longitudinal studies are needed to explore the causal associations and explanatory mechanisms behind gender differences.

State-of-the-art deep learning-based models used to address hand challenges, e.g. 3D hand joint estimation, need a vast amount of annotated data to achieve a good performance. The lack of data is a problem of paramount importance. Consequently, the use of synthetic datasets for training deep learning models is a trend and represents a promising avenue to improve existing approaches. Nevertheless, currently existing synthetic datasets lack of accurate and complete annotations, realism, and also rich hand-object interactions. For this purpose, in our work we present a synthetic dataset featuring rich hand-object interactions in photorealistic scenarios. The applications of our dataset for hand-related challenges are unlimited. To validate our data, we propose an initial approach to 3D hand joint estimation using a graph convolutional network feeded with point cloud data. Another point in favour of our dataset is that interactions are performed using realistic objects extracted from the YCB dataset. This could allow to test trained systems with our synthetic dataset using images/videos manipulating the same objects in real life.

This paper designs a real-time human hand following system based on multi-vision sensors. Through the KinectV2 camera, human hand behavior can be observed; the pose information of the human hand joint can also be obtained by using OpenNI2 and NITE2 interface; calculating the angle information of each joint of the six-degree-of-freedom robot can be achieved by stereo geometric correlation calculation. Through LeapMotion, accurate human joint information is obtained, then calculating the finger distance to control manipulator's tension, which is smoothed by Kalman filtering. Control, simulation and visualization for real-time follow-up of the robotic arm and the human hand are achieved under the Robot Operating System(ROS). The final experimental results are verified by Moveit's simulation environment and Kinova's Jaco arm.

Background Identifying patient phenotypes using machine-learning (ML) techniques amidst the variability and heterogeneity of the clinical manifestations of psoriatic arthritis (PsA) could be the first critical step towards better understanding of the disease eventually leading to individualized medicine.1 Objectives To identify distinct clusters of patients with PsA based on patients’ tender joint (TJ) and swollen joint (SJ) counts and correlation patterns among TJ and SJ counts at baseline as captured in the secukinumab FUTURE trials program. Methods Pairwise correlations were explored among 76 SJ and 78 TJ measurements of >2,700 patients with PsA across 5 phase III studies with ≈425,000 data entries at baseline and were visualized using heatmaps. Due to high correlations between SJs and corresponding TJs, a composite variable “swollen/tender joint count” was constructed for each joint. Hierarchical clustering was then performed on the composite using “1-correlation” as the dissimilarity metric and Ward’s agglomeration method for pairwise grouping of joints. A dendrogram was used to visualize and assess the resulting joint groupings. Results The hierarchical clustering algorithm grouped the 78 individual joints into distinct and natural clusters (Figure 1A). At higher level of the dendrogram, the algorithm grouped separately all foot, larger (jaws, clavicles, ankles, hips, wrists, knees, shoulders, elbows), and hand joints. Cutting the dendrogram at 15 clusters separated all the joints into distinct groups; hand joints (distal and proximal phalanges, metacarpals and thumbs), and foot joints (distal and proximal phalanges, metatarsals and big toes). Similar clustering algorithms were explored to identify patient clusters at baseline with distinct swelling and tenderness patterns across the identified joint groups. High correlation between swelling/tenderness of the left and swelling/tenderness of the corresponding right joint was observed across all individual joints (Figure 1B); a high correlation was also observed between swelling and tenderness at all individual joints. More localized patterns showed that there is a gradual decrease in correlation (from highest to lowest) among TJs and SJs in adjacent vs non-adjacent fingers, which is evident from grey-scale patterns (Figure 1C). Specifically, a gradual decrease in correlation between the swelling of 2nd distal interphalangeal joint and the tenderness of the 2nd–5th distal phalanges was noted. Conclusion Machine learning methodology confirmed a natural grouping of joints in patients with psoriatic arthritis based on baseline swelling and tenderness and revealed complex correlation patterns. Additional cluster analyses have demonstrated distinct patient clusters across the identified joint groups. Further investigating potential associations of other disease manifestations such as skin and nail involvement to define additional phenotypes may explain differences in disease pathogenesis and treatment outcomes. Reference [1] Grys BT, et al., J Cell Biol. 2017; 216(1): 65-71. Disclosure of Interests Matthias Kormaksson Shareholder of: Novartis, Employee of: Novartis, Effie Pournara Shareholder of: Novartis, Employee of: Novartis, Gregory Ligozio Shareholder of: Novartis, Employee of: Novartis, Luminita Pricop Shareholder of: Novartis, Employee of: Novartis, Ken Abrams Shareholder of: Novartis, Employee of: Novartis, Bruce Kirkham Grant/research support from: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Consultant for: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Kristian Reich Consultant for: Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Celgene, Centocor, Covagen, Forward Pharma, Fresenius Medical Care, GlaxoSmithKline, Janssen-Cilag, Kyowa Kirin, Leo, Lilly, Medac, Merck Sharp & Dohme Corp., Novartis, Miltenyi Biotec, Ocean Pharma, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Takeda, UCB Pharma, Valeant, Xenoport; Speakers bureau: Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Celgene, Centocor, Covagen, Forward Pharma, Fresenius Medical Care, GlaxoSmithKline, Janssen-Cilag, Kyowa Kirin, Leo, Lilly, Medac, Merck Sharp & Dohme Corp., Novartis, Miltenyi Biotec, Ocean Pharma, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Takeda, UCB Pharma, Valeant, Xenoport, Iain McInnes Grant/research support from: AstraZeneca, Celgene, Compugen, Novartis, Roche, UCB Pharma, Consultant for: AbbVie, Celgene, Galvani, Lilly, Novartis, Pfizer, UCB Pharma

Background: Cyclic citrullinated peptides antibodies (anti-CCP) were described in primary Sjogren’s syndrome (pSS). However, its possible associations with joint erosions, synovitis and tenosynovitis on high resolution ultrasonography of hands and wrists (US) in pSS are uncertain. Objectives: To assess in pSS the US findings, and their possible associations with anti-CCP. Methods: We have evaluated 97 consecutive pSS patients (2016 ACR/EULAR Classification Criteria), of both sexes, aged 18-76 years, and without meeting the 1987 ACR classification criteria for rheumatoid arthritis (RA). Twenty RA patients (disease duration Results: Frequency of tenosynovitis on US was higher in the pSS group than in healthy controls (36.1 vs. 3.8%, p Conclusion: US detected higher frequencies of tenosynovitis and erosions in pSS patients than in healthy controls, and the numbers of synovitis and tenosynovitis correlated with ESSDAI, suggesting that US is an important tool for the evaluation of these patients. Moreover, grade 2/3 synovitis and moderate/large erosions appear to be relevant for the distinction between pSS and RA. The additional observation that erosions are associated with anti-CCP in pSS seems to characterize a subgroup of patients with a severe underlying mechanism of joint damage. Grant from FAPESP: 2015/03756-4. References: [1] Riente L, Scire CA, Delle Sedie A, et al. Ultrasound imaging for the rheumatologist. XXIII. Sonographic evaluation of hand joint involvement in primary Sjogren’s syndrome. Clin Exp Rheumatol. 2009;27(5):747-50. Disclosure of Interests: Lissiane Guedes: None declared, Elaine Leon: None declared, Margarete Vendramini: None declared, Tamyris Bocate: None declared, Karina Bonfiglioli Speakers bureau: Has received speaking fees from Roche, Pfizer, Bristol-Myers Squibb, Abbvie and Janssen., Eloisa Bonfa: None declared, Sandra Pasoto: None declared

Background Development of rheumatoid arthritis (RA) is characterized by a several years lasting phase of autoimmunity, characterized by the presence of anti-modified protein antibodies (AMPA), recognizing citrullinated, carbamylated or acetylated proteins, as well as rheumatoid factor (RF) which precedes the onset of clinical disease (1,2).High resolution peripheral quantitative (HR-pQCT) technique enables the depiction of small cortical changes in peripheral joints (3). Objectives To describe microstructural bone lesions in rheumatoid arthritis (RA) at-risk individuals using HR-pQCT technique, their relation to rheumatoid arthritis specific autoimmunity, particularly osteoclast-inducing citrullinated vimentin (cVIM) antibodies and their impact on the later development of RA. Methods Cortical micro-channels (CoMiCs) as well as volumetric cortical and trabecular bone densities were analyzed by high-resolution computed tomography in the hand joints of RA at-risk individuals. Anti-modified protein antibody (AMPA) response was profiled including reactivities against citrullinated proteins (vimentin, enolase, fibrinogen) as well as carbamylated and acetylated vimentin. All subjects were followed for the development of RA. Results RA at-risk subjects (all N=75) with high-level (>1000U) cVIM antibodies showed a broader AMPA response and significantly more severe microstructural changes (higher CoMiCs, lower cortical and trabecular bone volume) compared to subjects with low/no cVIM reactivity. High cVIM antibodies and microstructural changes (>15 radial CoMiCs/joint) were associated with the presence of arthralgia. Furthermore, progression to RA was high in subjects with high cVIM (53%) vs. those with low (22%) or no (5%) antibodies and those with microstructural changes (46%) vs. those without such changes (16%). Conclusion: cVIM antibodies are associated to microstructural changes in RA at-risk individuals and predict the onset of RA. These data support the concept of structural priming of joints by autoimmunity before the onset of RA. References [1] McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365:2205-19. [2] Catrina AI, Svensson CI, Malmstrom V, Schett G, Klareskog L. Mechanisms leading from systemic autoimmunity to joint-specific disease in rheumatoid arthritis. Nat Rev Rheumatol. 2017;13:79-86. [3] Werner D, Simon D, Englbrecht M, et al. Early Changes of the Cortical Micro-Channel System in the Bare Area of the Joints of Patients With Rheumatoid Arthritis. Arthritis Rheumatol. 2017;69:1580-7. Disclosure of Interests Arnd Kleyer Grant/research support from: Lilly, Consultant for: Lilly, Speakers bureau: Abbvie, David Simon Grant/research support from: Novartis, Consultant for: Lilly, Speakers bureau: Janssen, Cong Duy Bui: None declared, Axel Hueber Grant/research support from: Novartis, Pfizer, Consultant for: Lilly, Speakers bureau: Lilly, Novartis, Janssen, Abbvie, Holger Bang Employee of: Dr. Bang is employee of the diagnostic company Orgentec Diagnostika., Andreas Ramming Grant/research support from: Novartis, Jurgen Rech Grant/research support from: Bristol-Myers Squibb and Celgene (greater than $10,000), Consultant for: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi Aventis, and UCB (in total more than $10,000), Speakers bureau: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi Aventis, and UCB (in total more than $10,000), Gerhard Kronke Grant/research support from: Lilly, Pfizer, Speakers bureau: Novartis, Georg Schett: None declared