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Psoriasis is a chronic inflammatory disease mediated by T cell immunity. Programmed death 1 (PD-1), a coinhibitory receptor, plays an important role in immune regulation and maintaining peripheral tolerance. The aim of the study was to compare the expression of PD-1 on the peripheral T cells between psoriatic patients and healthy controls. The study included 75 psoriatic patients and 52 healthy volunteers. The percentages and absolute numbers of CD3+, CD4+, CD8+, CD4+PD-1+, and CD8+PD-1+ T cells were analyzed using flow cytometry. The absolute numbers and percentages of CD4+PD-1+ and CD8+PD-1+ T cells were significantly decreased in the psoriatic patients in comparison with the control group. No significant correlations were found between the absolute numbers and percentages of CD4+PD-1+ or CD8+PD-1+ T cells and clinical characteristics of psoriasis. Decreased PD-1 expression on the T cells may be responsible for impaired negative regulation of immune response in psoriasis pathogenesis. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of the current study was to examine the painful elbow, and in particular enthesitis, in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) using clinical examination, ultrasonography (US) and magnetic resonance imaging (MRI). Methods: Patients with elbow pain (11 with PsA and 9 with RA) were recruited. Clinical examination, US and MRI studies were performed on the same day. For enthesitis, the common extensor and flexor insertions and the triceps insertion were imaged (20 patients, giving a total of 60 sites with comparative data). Imaging was performed with the radiologists blinded to the diagnosis and clinical findings. US was used to assess 'inflammatory activity' (Power Doppler signal, oedema, tendon thickening and bursal swelling) and 'damage' (erosions, cortical roughening and enthesophytes). MRI was used to assess 'inflammation' (fluid in paratenon, peri-entheseal soft-tissue oedema, entheseal enhancement with gadolinium, entheseal oedema and bone oedema) and 'damage' (erosion, cortical roughening and enthesophyte). Results: Complete scan data were not available for all patients as one patient could not tolerate the MRI examination. No significant differences in imaging scores were found between PsA and RA. Analysis of damage scores revealed complete agreement between US and MRI data in 43/55 (78%) comparisons; in 10/55 (18%) cases the US data were abnormal but the MRI data normal; in 2/55 (4%) cases, the MRI data were abnormal and the US data normal. Analysis of the inflammation scores revealed complete agreement between US and MRI data in 33/55 (60%) comparisons; in 3/55 (5%) cases US data were abnormal but MRI data normal; in 19/55 (35%) cases the MRI data were abnormal and the US data normal. There was a poor relationship between assessments based on clinical examination and imaging studies. Readers could not accurately identify the disease from imaging findings. Conclusion: Based on our results, at the elbow, US and MR have different roles in assessing enthesitis, with US apparently the better diagnostic tool for assessing damage and MR the better tool for assessing inflammation. In this study enthesitis and synovitis in the painful elbow were found equally in cases of established RA and PsA. [ABSTRACT FROM AUTHOR]

Lytic polysaccharide monooxygenases (LPMOs) are carbohydrate-disrupting enzymes secreted by bacteria and fungi that break glycosidic bonds via an oxidative mechanism. Fungal LPMOs typically act on cellulose and can enhance the efficiency of cellulose-hydrolyzing enzymes that release soluble sugars for bioethanol production or other industrial uses. The enzyme PMO-2 from Neurospora crassa ( NcPMO-2) was heterologously expressed in Pichia pastoris to facilitate crystallographic studies of the fungal LPMO mechanism. Diffraction resolution and crystal morphology were improved by expressing NcPMO-2 from a glycoengineered strain of P. pastoris and by the use of crystal seeding methods, respectively. These improvements resulted in high-resolution (1.20 Å) X-ray diffraction data collection at 100 K and the production of a large NcPMO-2 crystal suitable for room-temperature neutron diffraction data collection to 2.12 Å resolution. [ABSTRACT FROM AUTHOR]

The insole shape and the resulting plantar stress distribution have a pivotal impact on overall health. In this paper, by Finite Element Method, maximum stress value and stress distribution of plantar were studied for different insoles designs, which are the flat surface and the custom-molded (conformal) surface. Moreover, insole thickness, heel’s height, and different materials were used to minimize the maximum stress and achieve the most uniform stress distribution. The foot shape and its details used in this paper were imported from online CT-Scan images. Results show that the custom-molded insole reduced maximum stress 40% more than the flat surface insole. Upon increase of thickness in both insole types, stress distribution becomes more uniform and maximum stress value decreases up to 10%; however, increase of thickness becomes ineffective above a threshold of 1 cm. By increasing heel height (degree of insole), maximum stress moves from heel to toes and becomes more uniform. Therefore, this scenario is very helpful for control of stress in 0.2° to 0.4° degrees for custom-molded insole and over 1° for flat insole. By changing the material of the insole, the value of maximum stress remains nearly constant. The custom-molded (conformal) insole which has 0.5 to 1 cm thickness and 0.2° to 0.4° degrees is found to be the most compatible form for foot. [ABSTRACT FROM AUTHOR]

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TNF therapy is effective for all aspects of psoriatic disease, but these drugs are costly and the long-term effects are unknown. Further, methotrexate causes concern with long-term adverse events. The purpose of this pilot study was to test the feasibility of drug withdrawal from patients with psoriatic arthritis, in stable low disease state. We examined the availability of patients, their willingness to participate, study procedures, and the proportion of patients in the withdrawal arm who relapsed during the study. Low disease state was defined by minimal disease activity criteria (MDA), and relapse by failure to achieve these criteria. Patients in the withdrawal group underwent a phased withdrawal of medication where the last treatment added was the first withdrawn. Assessments were monthly for 3 months before study exit. Seventy-two patients were invited to participate, of which 57 were found to be eligible. Twenty-six (36.1 %) subsequently attended the screening visit but 9 failed eligibility criteria so that 17 patients (29.8 % of the 57 eligible patients, 95 % confidence interval (CI) 18.4, 43.4 %) were randomised at a ratio of 2:1 in favour of the withdrawal arm (11 withdrawals, 6 standard care). Six patients experienced a flare, all of whom were in the withdrawal arm (relapse rate 54.6 %, 95 % CI 23.4, 83.3 %). Four of the flares were apparent from visit 3 (8 weeks after starting withdrawal). Given the high relapse rate, an alternative trial design of partial treatment withdrawal, possibly including a patient preference arm, is recommended. [ABSTRACT FROM AUTHOR]

A study was conducted to compare the gait pattern of 12 patients with ankylosing spondylitis with axial disease only with that of 11 healthy controls using a telemeterised electrogoniometer gait analysis system. The reproducibility of the gait variables was found to be acceptable. Angles for movement at the hip and knee were less in patients with ankylosing spondylitis, but hip/knee angle ratios did not differ between the two groups. The stride length was shorter in the patients with ankylosing spondylitis. These findings are due to the increased rigidity of the spine, which results in decreased shock absorption and consequently a more cautious gait pattern in the absence of clinically and radiologically detectable peripheral joint disease. [ABSTRACT FROM PUBLISHER]

The article presents a list of reviewers for journal articles submitted from October 2013 - September 2014 including T. Arayssi, C. Beaudart and V. Chandran.

Current diagnostics of patients' condition as well as assumed effects of the used medical diagnostic methods are a significant part of every medical treatment. The process of continuous gathering experience and comparing it with current knowledge leads to development of medical sciences and still growing effectiveness in practice. Numerous relations between particular human body systems and their interactions are very important for fast and precise diagnosis. In the paper, evaluation of the effects of neurosurgical procedures expressed as improvement of mechanical parameters of skeleton muscle system have been considered. The approach presented in the paper assumes description of results in terms of common physical units. [ABSTRACT FROM AUTHOR]

Objectives In disease modifying antirheumatic drug (DMARD)-naive early rheumatoid arthritis (RA), to compare the efficacy of methotrexate (MTX) and infliximab (IFX) with MTX and intravenous corticosteroid for remission induction. Methods In a 78-week multicentre randomised controlled trial, double-blinded to week 26, 112 treatment-naive RA patients (1987 American College of Rheumatology classification criteria) with disease activity score 44 (DAS44)>2.4 were randomised to MTX + IFX or MTX + single dose intravenous methylprednisolone 250 mg. A treat-to-target approach was used with treatment escalation if DAS44>2.4. In the IFX group, IFX was discontinued for sustained remission (DAS44<1.6 for 6 months). The primary outcome was change in modified total Sharp-van der Heijde score (mTSS) at week 50. Results The mean changes in mTSS score at week 50 in the IFX and intravenous steroid groups were 1.20 units and 2.81 units, respectively (adjusted difference (95% CI) -1.45 (-3.35 to 0.45); p=0.132). Radiographic nonprogression (mTSS<2.0) occurred in 81% vs 71% (OR 1.77 (0.56 to 5.61); p=0.328). DAS44 remission was achieved at week 50 in 49% and 36% (OR 2.13 (0.91 to 5.00); p=0.082), and at week 78 in 48% and 50% (OR 1.12 (0.47 to 2.68); p=0.792). Exploratory analyses suggested higher DAS28 remission at week 6 and less ultrasound synovitis at week 50 in the IFX group. Of the IFX group, 25% (14/55) achieved sustained remission and stopped IFX. No substantive differences in adverse events were seen. Conclusions In DMARD-naive early RA patients, initial therapy with MTX+high-dose intravenous steroid resulted in good disease control with little structural damage. MTX +IFX was not statistically superior to MTX+intravenous steroid when combined with a treat-to-target approach. [ABSTRACT FROM AUTHOR]

People that the editor would like to thank for their assistance in assessing manuscripts submitted to the journal are mentioned.

This document provides the abstracts of papers presented at the 2013 Annual Meeting of the American College of Rheumatology (ACR) which cover topics such as rheumatoid arthritis, systemic lupus erythematosus and innate immunity.

The objective of this study was to evaluate the long-term benefits of sharp scalpel debridement of painful forefoot plantar callosities in rheumatoid arthritis (RA). The null hypothesis: sharp scalpel debridement would offer no additional long-term advantage in terms of pain and function. Sixty-five people with RA were randomised to receive regular sharp scalpel debridement of painful forefoot plantar callosities in conjunction with a combined therapeutic approach or a combined therapeutic approach alone. The primary outcome measure was change at 18 months in participant-reported forefoot plantar pain measured by a 100-mm visual analogue scale (VAS). Secondary outcome measures were recorded at baseline and study exit and included revised Foot Function Index, Health Assessment Questionnaire, Foot Impact Scale and gait parameters. At 18 months, there were no differences between groups for the primary outcome VAS-measured forefoot plantar pain (left foot ( F = 0.23, p = 0.635), right foot ( F = 2.14, p = 0.148)). Within-group changes were highly significant (treatment arm, difference = 16.9 (95 % confidence interval (CI) 9.4, 24.4), t = 4.6, p < 0.0001; control arm, difference = 17.5 (95 % CI 9.4, 25.5), t = 4.4, p < 0.0001). There was little change in scores of overall function and foot impact in either group and there were no significant changes in gait parameters noted. The long-term effects of sharp scalpel debridement of painful forefoot plantar callosities in people with RA, when used in conjunction with a combined therapeutic approach, produced no additional benefit over the combined therapeutic approach alone. Trial registration [ABSTRACT FROM AUTHOR]

People who the editor would like to thank for their assistance in the reviewing of manuscripts during the period October 2011 to September 2012 are mentioned.

http://acrmeeting.wiley.com/ [ABSTRACT FROM AUTHOR]

Previous cadaveric studies have suggested that forefoot deformities at the metatarsophalangeal (MTP) joints in patients with rheumatoid arthritis (RA) might result from the failure of the ligamentous system and displacement of the plantar plates. This study aimed to examine the relationship between plantar plate pathology and the rheumatoid arthritis magnetic resonance imaging score (RAMRIS) of the lesser (second to fifth) MTP joints in patients with RA using high-resolution 3 T magnetic resonance imaging (MRI). In 24 patients with RA, the forefoot was imaged using 3 T MRI. Proton density fat-suppressed, T2-weighted fat-suppressed and T1-weighted post gadolinium sequences were acquired through 96 lesser MTP joints. Images were scored for synovitis, bone marrow oedema and bone erosion using the RAMRIS system and the plantar plates were assessed for pathology. Seventeen females and 7 males with a mean age of 55.5 years (range 37-71) and disease duration of 10.6 years (range 0.6-36) took part in the study. Plantar plate pathology was most frequently demonstrated on MRI at the fifth MTP joint. An association was demonstrated between plantar plate pathology and RAMRIS-reported synovitis, bone marrow oedema and bone erosion at the fourth and fifth MTP joints. In patients with RA, 3 T MRI demonstrates that plantar plate pathology at the lesser MTP joints is associated with features of disease severity. Plantar plate pathology is more common at the fourth and fifth MTP joints in subjects with RA in contrast to the predilection for the second MTP reported previously in subjects without RA. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the clinical characteristics of foot ulceration in patients with rheumatoid arthritis (RA). Adults with RA and current foot ulceration but without diabetes were recruited. Clinical examination included assessment of RA disease activity, foot deformity, peripheral vascular disease, neuropathy and plantar pressures. Location, wound characteristics and time to healing were recorded for each ulcer. Participants completed the Health Assessment Questionnaire and Leeds Foot Impact Scale. Thirty-two cases with 52 current ulcers were recruited. Thirteen patients (41%) experienced more than one current ulcer: 5 (16%) had bilateral ulceration, 15 (47%) had previous ulceration at a current ulcer site. The majority ( n = 33) of open ulcers were located over the dorsal aspect of the interphalangeal joints ( n = 12), plantar aspect of the metatarsophalangeal joints (MTPJs) ( n = 12) and medial aspect of first MTPJs ( n = 9). In ulcerated limbs ( n = 37), ankle brachial pressure index (ABPI) was <0.8 in 2 (5%); protective sensation was reduced in 25 (68%) and peak plantar pressures were >6 kg/cm in 6 (16%). Mean ulcer size was 4.84 by 3.29 mm. Most ulcers ( n = 42, 81%) were superficial; five (9.6%) were infected. Time to healing was available for 41 ulcers: mean duration was 28 weeks. Three ulcers remained open. In conclusion, foot ulceration in RA is recurrent and multiple ulcers are common. Whilst ulcers are small and shallow, time to achieve healing is slow, posing infection risk. Reduced protective sensation is common in affected patients. The prevalence of arterial disease is low but may be under estimated due to high intolerance of ABPI. [ABSTRACT FROM AUTHOR]

Objectives. Despite increased awareness of the high prevalence and significance of foot and ankle problems in rheumatoid arthritis (RA), feet remain neglected. Reasons may include the perception that feet are difficult to assess, they are not included in the DAS28, and lack of freely available foot screening tools specific for RA. Methods. The Swindon Foot and Ankle Questionnaire (SFAQ) is a simply worded 10-point foot and ankle screening questionnaire with diagrams of feet and ankles for use in general rheumatology outpatients. All RA patients on our electronic database were invited to complete the questionnaire and attend clinic for assessment. Patients assessed clinically were scored out of 10 using the parameters from the questionnaire. The SFAQ was compared to the Manchester Foot Pain and Disability Index (MFPDI), DAS28, HAQ, HAD, and OSRA scores. Results. 597 questionnaires were sent, 301 (50%) returned, and 137 seen in clinic. There was good correlation between the postal SFAQ score, clinic score (r = 0.63), and the MFPDI (r = 0.65). Neither of the foot scores correlated with other RA disease outcome measures. 75% patients completed the picture. 73% corresponded to clinical findings. 45% of patients required an intervention following clinical review and trended towards higher scores. Conclusions. The SFAQ was quick to complete and correlated with the MFPDI. Lack of association with standard RA outcome measures suggests that relying on these scores alone may miss foot pathology. The diagrams were a useful complement. This simple screening tool could aid identification of RA foot and ankle problems. [ABSTRACT FROM AUTHOR]

Shoulder disorders are common, debilitating, and represent a considerable burden on society. As primary contact practitioners, physiotherapists play a large role in the management and rehabilitation of people with these conditions. For those living outside of urban areas, however, access to physiotherapy can be limited. The aim of this study was to evaluate the validity and reliability of using a telerehabilitation system to collect physical examination findings and correctly identify disorders of the shoulder. Twenty-two participants with 28 shoulder disorders were recruited and underwent a face-to-face physical examination and a remote telerehabilitation examination. Examination findings and diagnoses from the two modes of assessment were used to determine validity and reliability of the new method. Diagnostic agreement and agreement on individual findings between the two methods were found to be consistent with the reliability of conventional assessment methods. This study provides important preliminary findings on the validity and reliability of musculoskeletal examinations conducted via telerehabilitation. [ABSTRACT FROM AUTHOR]

People that the author would like to thank for their assistance in assessing manuscripts submitted to Rheumatology during the period October 2010 to September 2011 are mentioned.

Rheumatoid arthritis is an inflammatory joint disease that can lead to pain, stiffness, and deformity, often with marked involvement of the small joints of the foot and ankle. Orthotic devices are commonly prescribed for this condition to lessen symptoms and improve function and mobility, and customized devices are most effective. The work reported in this paper has examined the feasibility of using an additive manufacturing-based approach to manufacture customized orthoses. In order to test feasibility, orthoses have been manufactured using the additive manufacturing technology of selective laser sintering, and have been evaluated through a small-scale patient trial (n = 7). The trial indicated that these orthoses performed as well as the patients' current prescribed customized devices in terms of the observed gait and subjective evaluation of fit and comfort. It is concluded that the feasibility of the additive manufacturing approach has been demonstrated, and further development of amass customization system to deliver orthoses, together with exploitation of the design freedom offered by the manufacturing method, will give the overall approach significant clinical potential. [ABSTRACT FROM AUTHOR]

For over 30 years, investigators have used the simple but non-validated classification criteria suggested by Moll and Wright. Several authors have suggested modifications to these but most remain unvalidated or require human leukocyte antigen analysis. Now, a worldwide initiative has developed new criteria which include both clinical and radiological features. These will require further study before they are fully adopted but their improved performance should result in less variation between study cohorts. The recurring question of disease heterogeneity continues to occupy researchers in this field. Despite recent pleas to abandon the original five sub-groups, a case can be made for retaining at least the two sub-groups of peripheral and axial disease and, possibly, splitting the peripheral disease into oligo- and poly-arthritis. [ABSTRACT FROM AUTHOR]

Abstract Background  It has been proposed that the defining difference between rheumatoid arthritis and spondyloarthropathy (including psoriatic arthritis) is the initial pathological lesion where the emphasis in psoriatic arthritis is on the enthesis and in rheumatoid arthritis on the synovium. Classical radiological descriptions of seronegative spondyloarthropathy include enthesopathy at major entheseal insertions characterised by erosions and exuberant new bone formation. In this study, the plain radiographic features of spondyloarthropathy are compared between psoriatic arthritis, other spondyloarthropathies and rheumatoid arthritis. Methods  The CASPAR study collected clinical, radiological and laboratory data on 588 patients with physician diagnosed psoriatic arthritis and 525 controls with other inflammatory arthritis, 70% of which had rheumatoid arthritis. Plain radiographs of the pelvis and heels were part of the study protocol, although radiographs of other potential entheseal sites such as the knee, elbow and shoulder, were interpreted if available. All radiographs were read blind by two observers working in tandem. Results  Significant differences in entheseal erosion and entheseal new bone formation were found between psoriatic arthritis, ankylosing spondylitis, undifferentiated spondyloarthropathy, rheumatoid arthritis and other diagnoses (entheseal erosion, chi-squared 20.8, p = 0.008; entheseal new bone formation, chi-squared 24.5, p = 0.001). These differences were mainly due to a higher proportion of these features in ankylosing spondylitis. No differences in the plain radiographic features of enthesopathy were found between psoriatic arthritis and rheumatoid arthritis except in the case of entheseal new bone formation at sites of attachment of inguinal ligament, sartorius and rectus femoris muscles to the ilium (OR 3.01, 95% CI 1.13–8.02). Very few subjects with symptomatic heel involvement had radiographic changes and minimal differences were found between those with and without symptoms in terms of new bone formation and erosion at either calcaneal site. Conclusions  New bone formation and erosion at major entheseal sites is most commonly seen in ankylosing spondylitis. Plain radiographic features of major enthesopathy are poor discriminators between psoriatic arthritis and rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Aims To investigate the relationship between limited joint mobility (LJM; measured both passively and during gait) and plantar pressure measurements. Methods A cross-sectional study involving 28 diabetic patients with peripheral neuropathy but no plantar ulceration (DN), 25 diabetic patients with ulceration (DU), 25 diabetic control patients with no ulceration or peripheral neuropathy (DC), and 25 non-diabetic reference subjects (NDR). Movements of the ankle joint complex (AJC) and 1st metatarsophalangeal (MTP) joint were recorded, together with plantar pressures. Results The passive range of motion at the AJC was significantly reduced in all the diabetes groups, but the gait range of motion was comparable with non-diabetic subjects. At the AJC, no correlation was found between the passive and gait range of motion (ROM) and these were not correlated with plantar pressure variables. At the 1st MTP, a correlation was found between the passive and gait dorsiflexion ROM and a significant correlation existed between gait dorsiflexion ROM at the 1st MTP joint and peak forefoot pressures in the DU group. Conclusions Despite a significant reduction in the passive ROM at the AJC in the diabetic groups, the gait ROM was indistinguishable from reference subjects and was not correlated with plantar pressure variables. At the 1st MTP joint, a correlation was found between the passive and gait ROM and furthermore the gait ROM was correlated with peak forefoot pressures, suggesting ROM measures at the 1st MTP joint may be preferable to ROM measures at the AJC. [ABSTRACT FROM AUTHOR]

Objective. To determine the effectiveness of a pictorial ‘mind map’ together with the Arthritis Research Campaign (ARC) booklet for imparting knowledge to participants with rheumatoid arthritis (RA). Also, we wished to relate this to their reading ability. [ABSTRACT FROM PUBLISHER]