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Background: Both vertebral bodies and posterior elements of the vertebrae (facet joints, FJ) can engage in bone formation in radiographic axial spondyloarthritis (r-axSpA). However, little is known about the specific structural lesions and progression patterns of FJs in r-axSpA. Objectives: To identify specific lesions related to r-axSpA and to investigate the distinct progression patterns by comparing the FJ changes of r-axSpA with that of diffuse idiopathic skeletal hyperostosis (DISH), osteoarthritis (OA), and control group (CG). Design: Single-center, retrospective study. Longitudinal imaging data were retrieved and collected. Methods: Age- and sex-matched patients with complete thoracic and lumbar spine computed tomography (CT) data were included and their bilateral FJs were assessed. FJ changes were divided into erosions, ankylosis, joint-space narrowing, osteophytes, subchondral sclerosis, subchondral cysts, and vacuum phenomena. Average progressed year was defined as "number of changed vertebrae × interval years"/number of changed vertebrae. Results: In all, 50 patients in each group were included. Subchondral cysts and vacuum phenomena were not observed. Bilateral FJ ankylosis (FJA)/erosions in the thoracic and lumbar spine, and unilateral ankylosis/erosions in T1–4, T9–12 were significantly more common in r-axSpA. Joint-space narrowing/osteophytes/subchondral sclerosis were significantly more common in DISH and OA. FJ lesions progressed in 56.34% of vertebrae of r-axSpA. The most common pattern was "FJ normal advanced to ankylosis" (17.54%) which required 2.63 years. It was followed by "erosions advanced to ankylosis" (12.3%) which took 2.05 years, and by "normal FJ advanced to erosions" (11.04%) which took 2.29 years, respectively. Degenerative changes could also progress to FJ erosions/ankylosis (24.83%). The majority pattern in DISH/OA was "FJ changes advanced to subchondral sclerosis/osteophytes/joint-space narrowing." Conclusion: Bilateral FJA/erosions are r-axSpA-specific lesions. The specific progression pattern for r-axSpA was "FJ changes advanced to ankylosis/erosions." Repeated CT examination in intervals of at least 2 years will be more appropriate for monitoring FJ progression. [ABSTRACT FROM AUTHOR]

This report describes the use of subcutaneous lidocaine infusion to manage complex pain associated with checkpoint inhibitor inflammatory arthritis. In addition, the safe administration of lidocaine in the home setting is described. A 49-year-old man with metastatic melanoma to lung, right axilla and posterior chest wall on regular pembrolizumab developed checkpoint inhibitor inflammatory arthritis. Pain associated with this was unresponsive to simple analgesia, escalating opioids and adjuvant analgesics. Lidocaine infusion was used on separate occasions (inpatient unit and home setting) to gain rapid and sustained control of inflammatory pain. Inflammatory pain responded well to 2 mg/kg/h lidocaine infusion over 4 days with sustained response between infusions of up to 6 wk. Resulting in improved mobility, functional status, and overall quality of life. Lidocaine infusion should be considered as an option for analgesic management of checkpoint inhibitor inflammatory arthritis in patients for whom usual treatment is ineffective, and as an opioid-sparing intervention. [ABSTRACT FROM AUTHOR]

Objective: Cancer survivors have unique healthcare needs. An important consideration for survivorship is chronic diseases and health risk factors. The purpose of this study is to describe demographics, risk factors, and comorbid health conditions in adult cancer survivors. Method: We analyzed 2019 Arizona Behavioral Risk Factor Surveillance System data to compare cancer survivors to non-cancer survivors (aged 18 or older) to assess differences between the two populations. Adjusted and unadjusted population-based estimates and 95% confidence intervals were calculated, and multivariable logistic regression models were performed. Results: Eight thousand nine-hundred and twenty (8920) respondents (1007 survivors; 7913 non-cancer survivors) were included. Compared to non-cancer survivors, cancer survivors were more likely to be female, 65 years and older, non-Hispanic white, veterans, and less likely to be employed. Survivors had higher rates of coronary heart disease, stroke, chronic obstructive pulmonary disease, kidney disease, hypertension, arthritis, multiple chronic conditions, being overweight, and being a former smoker. Survivors were more likely to report fair/poor health than non-cancer survivors. Discussion: These findings can be used by healthcare and public health practitioners to evaluate the programmatic efforts and resources, implement targeted interventions toward cancer survivors, and improve health and quality of life. [ABSTRACT FROM AUTHOR]

The article discusses the case of a pediatric patient with early onset polyarthritis which is an unusual presentation of major histocompatibility complex (MHC) class II deficiency. Topics discussed include the patient's presentation of multiple joint swellings and erythematous maculopapular rashes, the role of autoimmunity on the development of the arthritis, and hematopoietic stem cell transplantation as a curative option.

Objective: This study aimed to clinically compare patients with culture-negative (CN) adult knee septic arthritis and culture-positive (CP) adult knee septic arthritis patients. Materials and Methods: 51 patients who were operated on with the diagnosis of adult knee septic arthritis between June 2016 and May 2023 were retrospectively examined. While 23 patients with CN were called Group 1, 28 patients with CP were called Group 2. Age, gender, side, C-reactive protein (Crp) value at admission, culture results, hospital stay and follow-up periods were evaluated. In clinical evaluation, knee ROM (range of motion) and visual analog score (VAS) were evaluated. Results: Both groups had similar distributions in terms of age, gender, side and follow-up periods. Group 1's Crp level at admission and total hospital stay were lower than Group 2. (p=0.018/p=0.0001) ROM and VAS scores of both groups were similar. No patient developed deep infection. Conclusion: In CN adult knee septic arthritis patients, the average Crp values at the time of admission are lower and the hospital stay is shorter. Clinically, they have similar results to CP patients in terms of ROM and VAS. [ABSTRACT FROM AUTHOR]

Objectives Very little is known on the efficacy and safety of drugs for the management of chronic calcium pyrophosphate (CPP) crystal inflammatory arthritis. The objectives of this work were to describe the drugs used in the management of chronic CPP crystal inflammatory arthritis in expert European centres, and to examine treatment retention. Methods This was a retrospective cohort study. Charts from patients with a diagnosis of persistent inflammatory and/or recurrent acute CPP crystal arthritis were reviewed in seven European centres. Baseline characteristics were collected, and visits at months 3, 6, 12 and 24 included an assessment of treatment response and safety. Results One hundred and ninety-four treatments were initiated in 129 patients. Colchicine (used first-line in n  = 73/86), methotrexate (used first-line in n  = 14/36), anakinra (n  = 27) and tocilizumab (n  = 25) were the most prescribed treatments, while long-term corticosteroids, hydroxychloroquine, canakinumab and sarilumab were used occasionally. The 24-month on-drug retention was higher for tocilizumab (40%) than anakinra (18.5%) (P  < 0.05), while the difference between colchicine (29.1%) and methotrexate (44.4%) was not statistically significant (P  = 0.10). Adverse events led to 14.1% of colchicine discontinuations (100% of diarrhoea), 4.3% for methotrexate, 31.8% for anakinra and 20% for tocilizumab; all other discontinuations were related to insufficient response or losses to follow-up. Efficacy outcomes did not differ significantly between treatments throughout follow-up. Conclusion Daily colchicine is the first-line therapy used in chronic CPP crystal inflammatory arthritis, which is considered efficient in a third to half of cases. Second-line treatments include methotrexate and tocilizumab, which have higher retention than anakinra. [ABSTRACT FROM AUTHOR]

Objective Joint involvement in SLE is the most frequent manifestation and shows a wide heterogeneity. It has not a valid classification and it is often underestimated. Subclinical inflammatory musculoskeletal involvement is not well known. We aim to describe the prevalence of joint and tendon involvement in hand and wrist of SLE patients, either with clinical arthritis, arthralgia or asymptomatic and compare it with healthy subjects using contrasted MRI. Methods SLE patients fulfilling SLICC criteria were recruited and classified as follows: group (G) 1: hand/wrist arthritis, G2: hand/wrist arthralgia, G3: no hand/wrist symptoms. Jaccoud arthropathy, CCPa and RF positivity, hand OA or surgery were excluded. Healthy subjects (HS) were recruited as controls: G4. Contrasted MRI of non-dominant hand/wrist was performed. Images were evaluated following RAMRIS criteria extended to PIP, Tenosynovitis score for RA and peritendonitis from PsAMRIS. Groups were statistically compared. Results A total of 107 subjects were recruited (G1: 31, G2:31, G3:21, G4:24). Any lesion: SLE patients 74.7%, HS 41.67%; P 0.002. Synovitis: G1: 64.52%, G2: 51.61%, G3: 45%, G4: 20.83%; P 0.013. Erosions: G1: 29.03%; G2: 54.84%, G3: 47.62%; G4: 25%; P 0.066. Bone marrow oedema: G1: 29.03%, G2: 22.58%, G3: 19.05%, G4: 0.0%; P 0.046. Tenosynovitis: G1: 38.71%; G2: 25.81%, G3: 14.29%, G4: 0.0%; P 0.005. Peritendonitis: G1: 12.90%; G2: 3.23%, G3: 0.0%, G4: 0.0%; P 0.07. Conclusion SLE patients have a high prevalence of inflammatory musculoskeletal alterations confirmed by contrasted MRI, even if asymptomatic. Not only tenosynovitis but peritendonitis is also present. [ABSTRACT FROM AUTHOR]

Objectives: To characterize patients evaluated in our Early Arthritis Clinic (EAC) in the first ten years; to assess diagnostic delay and its underlying causes; and to evaluate the level of agreement between the referring physician and the rheumatologist regarding the presence of referral criteria. Methods: Cross-sectional study including patients attending EAC between 2012 and 2021. Demographic data, provenience, final diagnosis, referral criteria and time related to diagnosis delay were retrieved from clinical files and the Portuguese Registry of Rheumatic Patients (reuma.pt). Characteristics of the patients and the time variables were analysed with descriptive statistical analysis. The agreement between the referring physician and rheumatologist regarding the referral criteria was evaluated using Cohen's Kappa. Results: A total of 440 patients (68.9% females, mean age of 54.0±16.7 years) were referred, mostly from primary care (71.6%). Inflammatory Rheumatic Disease was diagnosed in 65.7% of the patients, with 58.9% classified as early arthritis. The median time from onset of symptoms to referral for EAC was 76 days (IQR 33.5-144.0); the median time from referral to the first EAC was 34 (IQR 19.0-46.0) days, and the median time from onset of symptoms to first EAC was 114.5 (IQR 66.8-190.3) days (16.3 weeks). Only about 10% were observed by a rheumatologist within the first six weeks following the onset of symptoms. The level of agreement between the referring physician and the rheumatologist was slight to fair to clinical criteria (Cohen´s Kappa 0.09-0.29) and moderate to substantial to laboratory criteria (Cohen´s Kappa 0.43-0.62). Conclusions: Patients with suspected early arthritis experience significant diagnostic delay, with the time elapsed between symptom onset and referral identified as a major contributor. A low agreement between referral and rheumatologists suggests that non-rheumatologists education/training is needed. Identifying the barriers that prevent the adequate referral of patients is necessary to define strategies to improve it. [ABSTRACT FROM AUTHOR]

Locked metacarpophalangeal joint (MCPJ) is mainly caused by joint pathologies, although tendinopathy is also a possible cause. Furthermore, it can be misdiagnosed as tendinopathy with triggering symptoms. Herein, we present a 60-year-old housewife with thumb flexion inability lasting for 4 months. Three weeks previously, she visited another clinic and was misdiagnosed with trigger thumb. Her symptoms did not resolve after trigger thumb surgery. At our clinic, physical examination and imaging studies were conducted. Sesamoid arthritic change with entrapment in the MCPJ was found, and the entrapped sesamoid bone inhibited flexion of the MCPJ of the thumb. Based on the examinations, radial sesamoidectomy was planned. After surgery, the patient recovered a passive full range of motion immediately. Despite a rehabilitation program, at 6 months postoperatively, severe stiffness and contracture at the MCPJ were noted. Therefore, a second operation with tenolysis and volar plate release was conducted under wide-awake anesthesia. Intraoperatively, severe adhesion was observed in flexor tendon, volar plate release was performed, and small defects were found in the volar plate when thumb was fully extended. To prevent secondary healing of the volar plate defect, a dorsoradial adipofascial flap was used. At 6 months after the second surgery, the patient's range of motion in the MCPJ had improved, and she resumed activities of daily living without other complications. Hand surgeons frequently misdiagnose conditions as trigger finger if there is triggering or locked-joint symptoms. An accurate preoperative diagnosis with a detailed physical examination and imaging studies are essential for better operative results. [ABSTRACT FROM AUTHOR]

Objectives: Hip involvement remains a predictor of severe juvenile idiopathic arthritis (JIA) course and carries a high risk of disability. This study aims to determine the factors of poor prognosis of hip involvement in patients with JIA and to assess the treatment response. Methods: This is a multicenter observational cohort study. Patients were selected from the JIR Cohort database. Hip involvement was defined as clinically suspected and confirmed by an imaging tool. Follow‐up data were collected during 5 years. Results: Among the 2223 patients with JIA, 341(15%) patients had hip arthritis. Male gender, enthesitis‐related arthritis, and North African origin were factors associated with hip arthritis. Hip inflammation was associated with disease activity parameters during the first year, particularly Physician Global Assessment, joint count, and inflammatory marks. Structural hip progression was associated with early onset of the disease, a longer time to diagnosis, geographic origin, and JIA subtypes. Anti‐TNF therapy was found to be the only treatment able to effectively reduce structural damage progression. Conclusion: The early onset diagnostic delay, origin, and systemic subtype of JIA predict a poor prognosis of hip arthritis in children with JIA. The use of anti‐TNF was associated with a better structural prognosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the single-center experience of the efficacy and safety profile of biologic therapies in patients with juvenile idiopathic arthritis (JIA) and identify risk factors associated with adverse events (AEs). Methods: The medical charts of children with JIA diagnosed between January 2010 and December 2021 were reviewed retrospectively, and patients treated with biological agents were included in the study. Demographic data, clinical features, laboratory results, treatments used, and AEs during the treatment period were collected. Results: From the total JIA cohort (n=814), 237 patients who received biologic therapy for at least 3 months were enrolled in the study. The most frequent subtype was persistent oligoarticular JIA (45.1%) and the most frequently used biologic drug was etanercept (n=118), followed by adalimumab (n=64), tocilizumab (n=31), anti-interleukin-1 (anti-IL-1) agents (n=12; 7 anakinra and 5 canakinumab), infliximab (n=6), abatacept (n=3), secukinumab (n=2) and tofacitinib (n=1). One hundred sixty-four (69.2%) patients received disease-modifying antirheumatic drugs (DMARDs) concomitantly, 10.5% received DMARDs plus corticosteroids and 2.1% received only corticosteroids. The median [interquartile range (IQR)] age and median age at initiation of the biologics were 14.4 (10.7-18) years and 10.9 (6.6-14.5) years, respectively. The median (IQR) follow-up period was 3.9 (2-6.3) years. On biologic therapy, the median (IQR) JADAS-71 decreased from 13 (11-19) at baseline to 0 (0-2) after median 22 (10-40) months of treatment (p<0.001). The most frequent AE was local injection site reactions with biologics administered subcutaneously (n=8), followed by upper respiratory tract infections (n=4) and diffuse erythematous skin rashes (n=4). Serious AEs were observed in 11 (4.6%) patients. To compare the frequency of AEs, patients were divided into three groups according to the biologics administered, as follows: Group 1: Tumor necrosis factor inhibitors, group 2: anti-IL-1 agents, group 3: anti-IL-6 agent. The frequency of AEs was significantly higher in JIA patients on anti-IL-1 therapy than in the other two groups (58.3% vs. 29% and 8.5%, p<0.001). Conclusion: Biological agents are used with increasing frequency in children with JIA, and their off-label use is quite common. Although these agents are considerably effective and quite safe, AEs should not be underestimated. While planning the management of patients with refractory JIA, careful interpretation of benefit-risk balance for every individual patient seems to be reasonable and required. [ABSTRACT FROM AUTHOR]

Introduction: Synovial fluid (SF) analysis is one of the most important tests used in approach to arthritis and is necessary for rheumatology fellowship training. It depends on the operator's experience and can be affected by handling, processing, temperature, type of preservative, and time from aspiration to analysis. Therefore, we aimed to reevaluate the SF with positive results for crystals, after at least 10 days for the persistency and visibility of the crystals. Method: For 1 year, we reevaluated crystal positive synovial fluid samples after at least 10 days under light and polarized microscopy. The samples were sent in tubes without any preservative. After the first day of diagnosis of a crystal arthropathy, all the samples were kept in 4 °C refrigerator in a syringe without any preservative and then reevaluated. Results: 14 calcium pyrophosphate (CPP); 12 monosodium urate (MSU), 1 of which was combined CPP and MSU; and 1 post-methylprednisolone (Depomedrol) injection, steroid crystal arthropathy were found and reevaluated. In all reevaluated samples [between 10–24 (median:14 days)], the crystals were detectable again. Conclusion: Our results suggests that SF CPP, MSU and methylprednisolone crystals at 4 °C without preservation could be detectable after 10–24 days (median: 14, 15.5, and 10 days, respectively) under light and polarized microscopy. It seems that the samples evaluated in emergency settings without enough time and those sent from other centers or gathering samples for trainees can be kept to detect crystals at least 10 days for all and till 22 days (for CCP and MSU) after sampling. [ABSTRACT FROM AUTHOR]

Background: Although patellofemoral arthritis is a common and debilitating orthopedic disorder, its treatment varies and remains controversial. This review aims to provide an overview of the current understanding of the pathophysiology of patellofemoral arthritis, as well as its various diagnostic and treatment options. Current Concepts: The pathophysiology of patellofemoral arthritis includes lower limb malalignment, trochlear and/or patellar dysplasia, patellar instability, trauma, and obesity. The disorder is characterized by chronic anterior knee pain aggravated by flexion of the knee joint. A critical imaging study of the Merchant and lateral knee radiographs may show the progression of patellofemoral arthritis and dysplasia of the patellofemoral joints. Non-pharmacologic treatment options for patellofemoral arthritis include patient education, self-management, exercise, weight loss, taping, bracing, and orthotics. Pharmacologic agents (non-steroidal anti-inflammatory drugs, acetaminophen, oral narcotics, and duloxetine) and intra-articular injection therapies (glucocorticoids, hyaluronic acid, platelet-rich plasma, and other regenerative therapies) can be helpful for symptom relief in patients with patellofemoral arthritis. The surgical treatment can begin with lateral retinacular release to realign and decompress the patellofemoral joint. If failure in the improvement of symptoms is noted, a tibial tubercle osteotomy can be considered in young and active patients. While the early design and technique of patellofemoral arthroplasty were less than encouraging, more recent implant design and surgical techniques have demonstrated robust results. Discussion and Conclusion: Patellofemoral arthritis is a unique entity compared with tibiofemoral arthritis marked by distinct epidemiology, biomechanics, and risk factors and treatment options. It is essential to understand its pathophysiology and ensure proper treatment options. Background: Although patellofemoral arthritis is a common and debilitating orthopedic disorder, its treatment varies and remains controversial. This review aims to provide an overview of the current understanding of the pathophysiology of patellofemoral arthritis, as well as its various diagnostic and treatment options. Current Concepts: The pathophysiology of patellofemoral arthritis includes lower limb malalignment, trochlear and/or patellar dysplasia, patellar instability, trauma, and obesity. The disorder is characterized by chronic anterior knee pain aggravated by flexion of the knee joint. A critical imaging study of the Merchant and lateral knee radiographs may show the progression of patellofemoral arthritis and dysplasia of the patellofemoral joints. Non-pharmacologic treatment options for patellofemoral arthritis include patient education, self-management, exercise, weight loss, taping, bracing, and orthotics. Pharmacologic agents (non-steroidal anti-inflammatory drugs, acetaminophen, oral narcotics, and duloxetine) and intra-articular injection therapies (glucocorticoids, hyaluronic acid, platelet-rich plasma, and other regenerative therapies) can be helpful for symptom relief in patients with patellofemoral arthritis. The surgical treatment can begin with lateral retinacular release to realign and decompress the patellofemoral joint. If failure in the improvement of symptoms is noted, a tibial tubercle osteotomy can be considered in young and active patients. While the early design and technique of patellofemoral arthroplasty were less than encouraging, more recent implant design and surgical techniques have demonstrated robust results. Discussion and Conclusion: Patellofemoral arthritis is a unique entity compared with tibiofemoral arthritis marked by distinct epidemiology, biomechanics, and risk factors and treatment options. It is essential to understand its pathophysiology and ensure proper treatment options. [ABSTRACT FROM AUTHOR]

Objective: MRI of small joints plays an important role in the early detection and early treatment of rheumatoid arthritis. Despite its sensitivity to demonstrate inflammation, clinical use is hampered by accessibility, long scan time, intravenous contrast, and consequent high costs. To improve the feasibility of MRI implementation in clinical practice, we introduce a modified Dixon sequence, which does not require contrast and reduces total acquisition time to 6 min. Because the reliability in relation to conventional MRI sequences is unknown, we determined this. Methods: In 29 consecutive early arthritis patients, coronal and axial T2-weighted modified Dixon acquisitions on 3.0 T MRI scanner were acquired from metacarpophalangeal 2–5 to the wrist, followed by the standard contrast-enhanced protocol on 1.5 T extremity MRI. Two readers scored osteitis, synovitis and tenosynovitis (summed as total MRI-inflammation), and erosions (all summed as total Rheumatoid Arthritis MRI Score (RAMRIS)). Intraclass correlation coefficients (ICCs) between readers, and comparing the two sequences, were studied. Spearman correlations were determined. Results: Performance between readers was good/excellent. Comparing modified Dixon and conventional sequences revealed good/excellent reliability: ICC for total MRI-inflammation score was 0.84 (95% CI:0.70–0.92), for erosions 0.90 (95% CI:0.79–0.96), and for the total RAMRIS score 0.88 (95% CI:0.77–0.94). The scores of total MRI-inflammation, total erosions, and total RAMRIS were highly correlated (ρ = 0.80, ρ = 0.81, ρ = 0.82, respectively). Conclusion: The modified Dixon protocol is reliable compared to the conventional MRI protocol, suggesting it is accurate to detect MRI inflammation. The good correlation may be the first step towards a patient-friendly, short and affordable MRI protocol, which can facilitate the implementation of MRI for early detection of inflammation in rheumatology practice. [ABSTRACT FROM AUTHOR]

Multicentric Reticulohistiocytosis is a rare disorder of unknown aetiology which affects skin and joints predominantly. There are no specific laboratory investigations for diagnosis. Diagnosis can be made clinically and on a histopathological basis. There is no consensus on treatment. We report a case from Pakistan with classical presentation who did well on methotrexate and low dose steroids. Prompt diagnosis and early treatment may save from significant disability. [ABSTRACT FROM AUTHOR]

Background: In a healthy organism, oxidants and antioxidants are in balance. However, in cases such as inflammation, infection, and stress, this balance is disrupted in favor of oxidants, creating oxidative stress that can cause damage to cells or tissues. It is known that oxidative stress plays a role in the pathogenesis of many diseases. Determination of oxidant and antioxidant balance, especially in inflammatory diseases, plays an important role in elucidating the pathogenesis of the disease and developing treatment strategies. This study, it was aimed to reveal the oxidant status in inflammatory disease of calves with septic and aseptic arthritis. Materials, Methods & Results: The material of the study consisted of 21 calves up to 2 months old, of different races and genders, 14 (9 male, 5 female) with arthritis and 7 healthy (control, 5 male, 2 female). Of the calves with arthritis, 11 were septic and 3 were acute aseptic. In the calves with arthritis, the affected joint or joints were determined by clinical examinations. By palpating the joints, swelling, local temperature increase, tension in the joint capsule, presence of pain, and the presence and severity of lameness were examined. The color, clarity, viscosity, odor, and clot formation of the synovial fluid were examined and determined to be septic or aseptic. To determine the antioxidant status, the levels of malondialdehyde (MDA), which is the most important oxidative stress marker, and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT), which are the enzymatic antioxidant enzymes, were measured spectrophotometrically in serum samples. Vitamin E, C, and A levels, which are nonenzymatic antioxidants, were also measured colorimetrically. In the clinical examination, lameness was detected in the relevant extremity of all patients with arthritis. In the macroscopic examination of the synovial fluids taken from animals with arthritis, the colors of the synovial fluids varied between yellow and yellow tones in 11 cases; in 3 cases, it was determined that they were red and brown. It was observed that the colors of the synovial fluids were transparent in the subjects in the control group. It was observed that the synovial fluid clarity of the calves with arthritis was lost, with severe turbidity (+++) in 3 cases, moderately turbid (++) in 6 cases, slightly turbid (+) in 2 cases, and clear (-) in 3 cases. It was observed that the viscosity of synovial fluid taken from calves with arthritis decreased in varying degrees according to the severity of the disease, severe (+++) in 5 cases, moderately decreased (++) in 4 cases, slightly decreased (+) in 2 cases, and normal in 3 cases. It was determined that the viscosity of the synovial fluid taken from the calves in the control group was normal. There was a statistically significant difference between the groups in terms of MDA (P < 0.01), SOD (P < 0.01), GSH-Px (P < 0.05), vitamin E (P < 0.001), and vitamin C (P < 0.01), while MDA levels increased in calves with arthritis, SOD and GSH-Px activities and vitamin E and C levels decreased significantly. Although there was no statistically significant difference in CAT (P > 0.05) enzyme activity, it was determined that it was at a lower level in calves with arthritis, and there was no significant difference between the groups in terms of vitamin A (P > 0.05). Discussion: According to the results of the study, there is an increase in oxidative stress and a decrease in antioxidant status in calves with arthritis. It is thought that these changes may be due to efforts to reduce tissue damage by reducing lipid peroxidation. As a result, it was determined that oxidant and antioxidant balance was impaired in calves with arthritis, and oxidative stress and lipid peroxidation developed due to the increase in free radicals. It is thought that giving additional antioxidants to the calves may contribute to the recovery of the disease and reduce treatment costs. [ABSTRACT FROM AUTHOR]

While it is commonly acknowledged that the combined effect of lower limb orientation and ankle and hindfoot alignment play a fundamental role in ankle arthritis, supramalleolar/lower limb alignment has received less attention in valgus ankle arthritis. The purpose of this study was to analyze the lower limb alignment of patients with valgus ankle arthritis with primary origin, compared to that of varus ankle arthritis and normal controls. We hypothesized that patients with valgus ankle arthritis would have the opposite pattern of lower limb alignment as those with varus ankle arthritis. A retrospective radiographic analysis was performed on 61 patients (62 ankles, mean age, 59.3 ± 12 years) with primary valgus ankle arthritis. On preoperative radiographs, seven parameters, including talar tilt angle, medial distal tibial angle (MDTA), talar center migration, anterior distal tibial angle, talo-first metatarsal (Meary's) angle, hindfoot moment arm (HMA), and mechanical axis deviation (MAD), were measured and compared to those of primary varus ankle arthritis (n = 55; mean age, 59.7 ± 8.1 years) and control patients (n = 59; mean age, 29.3 ± 7.3 years). The valgus group had a significantly lower mean MDTA than the control group (p < 0.0001), indicating a varus distal tibial plafond in comparison to the control group. Meary's angle and HMA were significantly lower in the valgus group compared to the varus group (p < 0.05 and p < 0.0001, respectively), indicating a lower medial longitudinal arch and valgus hindfoot alignment. On whole limb radiographs, the valgus group showed a greater MAD than the control group, indicating varus lower limb alignment (p < 0.05). However, the MAD did not differ significantly between the valgus and varus groups (p = 0.7031). Our findings indicate that a significant proportion of ankles with primary valgus arthritis have a varus tibial plafond and a varus lower limb mechanical axis. This study contributes to our understanding of primary valgus ankle arthritis and suggests that lower limb alignment should be analyzed and considered throughout valgus ankle arthritis realignment procedures. [ABSTRACT FROM AUTHOR]

Purpose: We first developed a 4-1BB-targeted optical probe, named IRDye-680RD-4-1BB mAb (monoclonal antibody), and evaluated its value for the detection of 4-1BB+ activated T cells in vivo as well as the diagnosis of rheumatoid arthritis (RA) in an adjuvant-induced arthritis (AIA) mouse model. Methods: The 4-1BB expression pattern was analysed by flow cytometry and immunofluorescence (IF) staining. The 4-1BB mAb was conjugated with IRDye-680RD NHS ester, and characterized via fluorescence spectrum. A cell-binding assay was also performed to assess the interaction of this probe with activated and naïve murine T cells. Longitudinal near-infrared fluorescence (NIRF) imaging of the probe was performed at 6, 24, 48, 72, and 96 h after probe administration. Results: 4-1BB expression was highly upregulated during the pathogenesis of RA. Good colocalization was also observed between CD3 and 4-1BB by IF staining and t-SNE (T-distributed stochastic neighbour embedding) analysis, which indicates that 4-1BB was mainly expressed on T cells. Compared to the control group, a significantly higher signal was observed in the right hind paw (RP) of mice with AIA at all time points. The ex vivo biodistribution study results were consistent with the in vivo NIRF imaging results, which validated the accuracy of the region of interest (ROI) measurements. The sensitivity against 100% specificity observed in the receiver operator characteristic (ROC) curve analysis could distinguish the AIA group from the control group at all time points, indicating the value of IRDye-680RD-4-1BB mAb for RA diagnosis. Conclusion: We successfully developed a novel optical imaging probe, named IRDye-680RD-4-1BB mAb, for tracking 4-1BB+ activated T cells in vivo, and 4-1BB NIRF imaging is a promising strategy for noninvasively detecting the pathogenesis of RA. [ABSTRACT FROM AUTHOR]

Les études médicales ont connu dernièrement de nombreuses réformes. Ces changements se sont traduits par une modification dans la manière d'évaluer les étudiants. L'objectif de ce travail était de faire un état des lieux de l'évaluation des internes en rhumatologie en France depuis la réforme du 3e cycle. Un questionnaire a été envoyé à tous les CHU (centre hospitalo-universitaire) à l'attention des enseignants et des internes de rhumatologie pour évaluer l'organisation de la formation et des évaluations dans les différentes phases de formation. Les différents outils d'évaluations publiés et validés étaient assez peu connus ou utilisés par les enseignants. Leur utilisation variait en fonction de la phase de formation des internes et des centres, l'entretien avec le coordinateur étant la méthode la plus utilisée. La validation finale du DES (diplôme des enseignements supérieurs) était également hétérogène comprenant selon les centres des présentations orales, écrites ou de mémoires. Seul 1/3 des centres valident la formation en densitométrie contre 86 % pour la formation d'échographie. Un tiers des enseignants considère comme inutile l'évaluation formalisée des internes et 57 % étaient pour une harmonisation des modalités d'évaluation du DES. Enfin, 88 % des internes étaient favorables à une évaluation et 94 % considéraient qu'elle devait être formative et non sanctionnante. Malgré la réforme du 3e cycle, il persiste une hétérogénéité importante dans l'évaluation des internes avec des outils disponibles peu connus ou utilisés. Cependant, la majorité des internes sont pour une évaluation formalisée sur une dimension plutôt formative. [ABSTRACT FROM AUTHOR]

Small-joint involvement, including the interphalangeal joints of the hand, is less common in oligoarticular juvenile idiopathic arthritis (JIA). Ultrasound (US)-guided joint injections are also plausible for children. However, US-guided injections into pediatric small joints make the tips and tricks special because of the more difficult injection technique and greater risk of potential complications than with large joints. Here, we report the tips and tricks of serial US-guided interphalangeal joint injections in a male child with oligoarticular JIA who progressed to extended polyarthritis after an initial 6-month follow-up. [ABSTRACT FROM AUTHOR]

Objectives Identifying patients that will develop RA among those presenting with undifferentiated arthritis (UA) remains a clinical dilemma. Although MRI is helpful according to EULAR recommendations, this has only been determined in UA patients not fulfilling 1987 RA criteria, while some of these patients are currently considered as RA because they fulfil the 2010 criteria. Therefore, we studied the predictive value of MRI for progression to RA in the current UA population, i.e. not fulfilling RA classification criteria (either 1987 or 2010 criteria) and not having an alternate diagnosis. Additionally, the value of MRI was studied in patients with a clinical diagnosis of UA, regardless of the classification criteria. Methods Two UA populations were studied: criteria-based UA as described above (n  = 405) and expert-opinion-based UA (n  = 564), i.e. UA indicated by treating rheumatologists. These patients were retrieved from a large cohort of consecutively included early arthritis patients that underwent contrast-enhanced MRI scans of hand and foot at baseline. MRIs were scored for osteitis, synovitis and tenosynovitis. Patients were followed for RA development during the course of 1 year. Test characteristics of MRI were determined separately for subgroups based on joint involvement and autoantibody status. Results Among criteria-based UA patients (n  = 405), 21% developed RA. MRI-detected synovitis and MRI-detected tenosynovitis were predictive for progression to RA. MRI-detected tenosynovitis was independently associated with RA progression (odds ratio (OR) 2.79; 95% CI 1.40, 5.58), especially within ACPA-negative UA patients (OR 2.91; 95% CI 1.42, 5.96). Prior risks of RA development for UA patients with mono-, oligo- and polyarthritis were 3%, 19% and 46%, respectively. MRI results changed this risk most within the oligoarthritis subgroup: positive predictive value was 27% and negative predictive value 93%. Similar results were found in expert-opinion-based UA (n  = 564). Conclusion This large cohort study showed that MRI is most valuable in ACPA-negative UA patients with oligoarthritis; a negative MRI could aid in preventing overtreatment. [ABSTRACT FROM AUTHOR]

If left untreated psoriatic arthritis (PsA) can result in progressive, irreversible joint damage causing chronic pain and disability. It is a chronic, autoimmune inflammatory condition that can affect up to 30% of patients with psoriasis. PsA is a multisystem disease affecting other organs such as the eyes, gut and tendons. It is associated with multiple comorbidities such as diabetes mellitus, cardiovascular disease and metabolic syndrome. Early diagnosis is crucial as structural joint damage can occur within the first two years of disease onset. Symptoms in PsA patients have traditionally been divided into six domains: peripheral arthritis, enthesitis, dactylitis, axial disease, psoriasis and nail disease. Patients do not need to have symptoms in all domains for diagnosis, but examination of these six domains is important when assessing patients, prior to making a referral to rheumatology. If PsA is suspected in primary care, routine blood tests should be requested to check for anaemia of chronic disease and raised inflammatory markers. Plain radiographs of hands and feet should be requested prior to referral, although classical changes do not occur early in the disease. If GPs suspect PsA, prompt referral is paramount. Patients should be referred if they have persistent joint symptoms, a positive screening questionnaire (PEST), joint swelling, dactylitis or enthesitis, and/or inflammatory back pain. [ABSTRACT FROM AUTHOR]

If the alignment of a leg prosthesis is inadequate there will be the danger of arthritic defects occurring in the preserved knee joint. Acoustic-kinetic joint analysis in orthopaedic technology allows monitoring of the knee joint of an amputee after the alignment of a leg prosthesis and to recognize early joint defects resulting in adaptation of the alignment of the prothesis. A test rig was developed which includes acoustic emission analysis of the knee, video-based gait analysis, ground reaction force measurement and the measurement of the holding forces of the hands. During the examination a subject must do 3 one-legged knee bends during 10 sec with the preserved leg. To support the subject two grab handles were fixed with force sensors to a frame. A series of 6 measurements were recorded with breaks of 2 min. The recorded forces of the leg show a double hump pattern during the knee bend. The rising edge of the flexion phase was not uniform. The forces show no conclusive uniform pattern. The fitness of the probands acts as an indicator for the pattern of the force signals. The signals of the measurements show the necessity of the support for both hands to execute a one-legged knee bend. The understanding of the 3 measured forces is important for the arthritic diagnosis of the knee joint. [ABSTRACT FROM AUTHOR]

Objectives: Examine the effects of prevalent and newly diagnosed arthritis on changes in perceived physical demands and general work stress. Methods: Conditional change logistic regression models examined the strength of association between arthritis and perceived (1) work stress and (2) physical demands, using data from the NIDI Pension Panel Study (n = 2099). Results: Prevalent and newly diagnosed arthritis were associated with increased odds of perceived work stress and high physical demands. Manual workers with newly diagnosed arthritis exhibited a 6.73-fold (95% CI = 2.87–15.77) increased odds of physical demands. Arthritis in three body extremities was differentially associated with increased odds of work stress and physical demands in manual and non-manual workers. Discussion: Prevalent and incident arthritis were associated with changes in work stress and physical demands in older workers. Policies and workplace interventions to reduce stress and physical demands and improve workability in older workers with arthritis are needed. [ABSTRACT FROM AUTHOR]

Purpose: To report the case of a young boy with early onset high myopia (eoHM), foveal hypoplasia and skeletal dysplasia due to a homozygous LOXL3 pathogenic variant. Atypically, this was from a paternal uniparental isodisomy (UPiD) of chromosome 2., Clinical Case: Four-year-old boy with several months history of holding items close to his face was found to have reduced visual acuity 6/30 in both eyes, bilateral vitreous syneresis, foveal hypoplasia and bilateral high myopia (-8.50D). A skeletal survey showed spondylo-epi-metaphyseal dysplasia. Whole-exome sequencing (WES) revealed a homozygous LOXL3 variant c.1448&#95;1449del, p.(Thr483Argfs*13), inherited through paternal UPiD of chromosome 2., Conclusion: To our knowledge, this is the first reported case of LOXL3 -associated eoHM, foveal hypoplasia and mild skeletal dysplasia due to the rare phenomenon of paternal UPiD of chromosome 2. This case further delineates the phenotype associated with LOXL3 pathogenic variants and supports truncating LOXL3 pathogenic variants being associated with a phenotypic spectrum; from isolated eoHM through to a Stickler syndrome-like phenotype.

Purpose: To document the long-term visual outcomes in patients with Blau syndrome., Methods: A retrospective institutional cohort study was conducted, and 13 patients with genetically confirmed Blau syndrome were included. Demographic and clinical data were collected from standardised medical charts. Baseline was defined as the first detected uveitis and data were recorded onwards at intervals of 1, 3, 5, 10, 15 and 20 years., Results: Anterior uveitis was the most common classification at baseline (57.1%). Among patients with documented uveitis lasting 10 years or more, all of them developed panuveitis. Median logMAR visual acuity at baseline was 0 (range -0.5; 0.7), 0.19 (range 0; 1.5) at year 5, and 0.7 (range 0.1 - no perception of light) at year 20, as recorded in 13, 16, and 10 eyes, respectively. All patients received treatment with topical and oral steroids, and multiple systemic immunosuppressants including biologics. Disease control, defined as having cells <1+ in both eyes and using topical steroid eye drops less than twice daily, was achieved in 14.3% to 37.5% of patients at the different time points. Cataract surgery was performed in 12 eyes of 8 patients, 3 eyes of 3 patients necessitated glaucoma surgery, and 4 eyes of 4 patients required surgery for retinal detachment., Conclusion: Uveitis associated with Blau syndrome commonly leads to severe, chronic panuveitis, requiring long-term systemic immunosuppression. Early diagnosis and timely initiation of biologics may prevent significant visual impairment.

Purpose: To report a previously undescribed finding of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in Stickler syndrome., Design: Noncomparative case series., Subjects: Twenty-two eyes with anomalous optic disc from 11 Stickler syndrome patients were identified and imaged., Methods: Peripapillary hyperreflective ovoid mass-like structures were graded using enhanced-depth imaging OCT (EDI-OCT) according to the consensus recommendations of the Optic Disc Drusen Studies Consortium. All EDI-OCT scans were obtained using the Heidelberg Spectralis (Heidelberg Engineering) with a dense horizontal raster (15 × 10°, 97 sections) centered on the optic nerve head and graded by 2 independent assessors. In case of disagreement, the image was graded by a third assessor. The presence of any coexisting optic disc drusen was also assessed using EDI-OCT and autofluorescence., Main Outcome Measures: The presence of PHOMS, clinical characteristics and genetic mutations., Results: A pilot sample of 22 eyes with phenotypic optic disc abnormalities from 11 Stickler syndrome patients were identified and imaged. Eight patients were female and 3 were male. The mean age was 31 years (13-58 years). Peripapillary hyperreflective ovoid mass-like structures were present in 91% (n = 20) of imaged eyes. Seventy percent (n = 14) were type 1 Stickler syndrome and 30% (n = 6) were type 2 Stickler syndrome. All eyes were myopic and the degree of myopia did not seem to affect whether or not PHOMS was present in this cohort. One eye with PHOMS had retinal detachment, and 77.3% (n = 17) of eyes had undergone 360 o prophylactic retinopexy. Thirty-two percent (n = 7) of eyes with PHOMS were present in patients with coexisting hearing loss and 22.7% (n = 5) had orofacial manifestation of Stickler syndrome in the form of a cleft palate. Seventy-seven percent (n = 15) of eyes with PHOMS were present in patients who reported joint laxity or symptoms of arthritis. No coexisting optic disc drusen were identified and raised intracranial pressure was also excluded after neurological investigation., Conclusions: These data suggest that PHOMS are a novel finding in Stickler syndrome patients and should be considered when evaluating the optic nerves of these patients., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine the value of a novel high-resolution thermographic marker in the detection of joint inflammation compared to joint ultrasound (US) and to suggest thermographic cut-off values of joint inflammatory activity., Methods: Infrared thermographies were performed in patients with inflammatory arthritides and healthy controls. Patients were moreover examined clinically and by joint-US [Power-Doppler-(PDUS), Greyscale-US (GSUS)]. Regions of interest (ROIs) were defined for every joint and absolute temperature values within the ROIs were documented. The hottest areas ("hotspots") were identified by a clustering algorithm and the Hotspot/ROI-Ratio (HRR)-values were calculated. Subsequently, the HRR of patient-joints with different grades of hypervascularity (PDUS I°-III°) were compared among each other and with PDUS 0° control-joints. Diagnostic HRR-performance was tested by receiver-operating-characteristics., Results: 360 joints of 75 arthritis-patients and 1,808 joints of 70 controls were thermographically examined. HRR-values were statistically different between PDUS I-III vs. PDUS 0 and vs. healthy subjects for all four joint groups as well as in the majority of cases between patient-joints with different grades of hypervascularity (PDUS I°-III°; p<0.05). Taking joint-US as a reference, the best performance of HRR was found at the level of the wrist-joints by an area under the curve (AUC) of 0.91 (95%CI 0.84-0.98) with a sensitivity of 0.83 and specificity of 0.88., Conclusions: HRR showed an excellent performance in the differentiation of joints with US inflammatory activity from non-inflamed joints. Moreover, HRR was able to differentiate between joints with different grades of hypervascularity, making HRR a promising tool to assist disease activity monitoring.

Objective: A shortage of rheumatologists has led to gaps in inflammatory arthritis (IA) care in Canada. Amplified in rural-remote communities, the number of rheumatologists practicing rurally has not been meaningfully increased, and alternate care strategies must be adopted. In this retrospective chart review, we describe the impact of a shared-care telerheumatology model using a community-embedded Advanced Clinician Practitioner in Arthritis Care (ACPAC)-extended role practitioner (ERP) and an urban-based rheumatologist., Methods: A rheumatologist and an ACPAC-ERP established a monthly half-day hub-and-spoke-telerheumatology clinic to care for patients with suspected IA, triaged by the ACPAC-ERP. Comprehensive initial assessments were conducted in-person by the ACPAC-ERP (spoke); investigations were completed prior to the telerheumatology visit. Subsequent collaborative visits occurred with the rheumatologist (hub) attending virtually. Retrospective analysis of demographics, time-to-key care indices, patient-reported outcomes, clinical data, and estimated travel savings was performed., Results: Data from 124 patients seen between January 2013 and January 2022 were collected; 98% (n = 494/504 visits) were virtual. The average age of patients at first visit was 55.6 years, and 75.8% were female. IA/connective tissue disease (CTD) was confirmed in 65% of patients. Mean time from primary care referral to ACPAC-ERP assessment was 52.5 days, and mean time from ACPAC-ERP assessment to the telerheumatology visit was 64.5 days. An estimated 493,470 km of patient-related travel was avoided., Conclusion: An ACPAC-ERP (spoke) and rheumatologist (hub) telerheumatology model of care assessing and managing patients with suspected IA in rural-remote Ontario was described. This model can be leveraged to increase capacity by delivering comprehensive virtual rheumatologic care in underserved communities., (Copyright © 2024 by the Journal of Rheumatology.)

Objective: Diagnostic pitfalls often arise in the community because of potentially misleading similarities between juvenile idiopathic arthritis (JIA) and Blau syndrome, an immune-related disorder caused by NOD2 gene mutations. It remains unclear in which population and to what extent next-generation sequencing techniques can aid in diagnosis., Methods: We evaluated clinical usefulness of targeted next-generation sequencing in previously diagnosed JIA. Participants were required to have symptoms and signs suspected of Blau syndrome, including at least uveitis or cutaneous lesions in addition to arthritis. Targeted sequencing was conducted on NOD2 gene to detect diagnostic variants classified as pathogenic or likely pathogenic for Blau syndrome. We assessed the molecular diagnostic yield and clinical implications for patient care., Results: Between 1 May 2008 and 1 June 2021, sequencing data were accrued from 123 previously diagnosed JIA (median age: 5 years; female: 62.6%). Targeted NOD2 sequencing yielded a positive molecular diagnosis of Blau syndrome in 21.1% (95% CI: 14.9%, 29.2%), encompassing six heterozygous missense mutations classified as pathogenic variants. Among those receiving a molecular diagnosis, changes in clinical management and treatment were considered as having occurred in 38.5%. Nine predictors were identified as being associated with a higher diagnostic yield, providing clinical clues to suspect the possibility of Blau syndrome., Conclusion: Among some patients with paediatric-onset arthritis complicated with uveitis or cutaneous lesions, reassessment of the diagnosis of JIA may be warranted. Targeted NOD2 sequencing established the molecular diagnosis of Blau syndrome in nearly one-fifth of these cases and provided clinically relevant information for patient-care decisions., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

According to the 2021 CDC sexually transmitted disease surveillance report, national cases of syphilis and gonorrhea continue to rise. Currently, South Dakota ranks #1 in syphilis and #2 in gonorrhea cases per 100,000 population. The higher incidence increases the likelihood South Dakota clinicians will encounter different presentations of syphilis and gonorrhea. Recently, we have seen patients presenting with acute STI related inflammatory arthritis. This review discusses the acute arthritic presentations associated with gonorrhea and syphilis and its treatment., (Copyright© South Dakota State Medical Association.)

Competing Interests: The authors declare no conflict of interest.

Objective: Genome‐wide association studies have connected PADI4, encoding peptidylarginine deiminase 4 (PAD4), with rheumatoid arthritis (RA). PAD4 promotes neutrophil extracellular trap (NET) formation. This study was undertaken to investigate the origin of PAD4 and the importance of NET formation in a C57BL/6 mouse model of arthritis. Methods: To permit the effective use of C57BL/6 mice in the collagen‐induced arthritis (CIA) model, we introduced the administration of granulocyte colony‐stimulating factor (G‐CSF) for 4 consecutive days in conjunction with the booster immunization on day 21. Mice with global Padi4 deficiency (Padi4−/−) and mice with hematopoietic lineage–specific Padi4 deficiency (Padi4Vav1Cre/+) were evaluated in the model. Results: G‐CSF significantly increased the incidence and severity of CIA. G‐CSF–treated mice showed elevated citrullinated histone H3 (Cit‐H3) levels in plasma, while vehicle‐treated mice did not. Immunofluorescence microscopy revealed deposition of Cit‐H3 in synovial tissue in G‐CSF–treated mice. Padi4−/− mice developed less severe arthritis and had lower levels of serum interleukin‐6 and plasma Cit‐H3, lower levels of Cit‐H4 in synovial tissue, and less bone erosion on micro–computed tomography than Padi4+/+ mice in the G‐CSF–modified CIA model. Similarly, Padi4Vav1Cre/+ mice developed less severe arthritis, compared with Padi4fl/fl mice, and presented the same phenotype as Padi4−/− mice. Conclusion: We succeeded in developing an arthritis model suitable for use in C57BL/6 mice that is fully compliant with high animal welfare standards. We observed a >90% incidence of arthritis in male mice and detectable NET markers. This model, with some features consistent with human RA, demonstrates that hematopoietic PAD4 is an important contributor to arthritis development and may prove useful in future RA research. [ABSTRACT FROM AUTHOR]

Background: Arthritis is a common condition, which frequently involves the hands. Patients with inflammatory arthritis have been shown to experience significant delays in diagnosis. Aim: To develop and test a screening tool combining an image of a patient's hands, a short series of questions and a single examination technique to determine the most likely diagnosis in a patient presenting with hand arthritis. Machine learning techniques were used to develop separate algorithms for each component, which were combined to produce a diagnosis. Methods: A total of 280 consecutive new patients presenting to a rheumatology practice with hand arthritis were enrolled. Each patient completed a nine‐part questionnaire, had photographs taken of each hand and had a single examination result recorded. The rheumatologist diagnosis was recorded following a 45‐min consultation. The photograph algorithm was developed from 1000 previous hand images and machine learning techniques were applied to the questionnaire results, training several models against the diagnosis from the rheumatologist. Results: The combined algorithms in the present study were able to predict inflammatory arthritis with an accuracy, precision, recall and specificity of 96.8%, 97.2%, 98.6% and 90.5% respectively. Similar results were found when inflammatory arthritis was subclassified into rheumatoid arthritis and psoriatic arthritis. The corresponding figures for osteoarthritis were 79.6%, 85.9%, 61.9% and 92.6%. Conclusion: The present study demonstrates a novel application combining image processing and a patient questionnaire with applied machine‐learning methods to facilitate the diagnosis of patients presenting with hand arthritis. Preliminary results are encouraging for the application of such techniques in clinical practice. [ABSTRACT FROM AUTHOR]

Juglans regia has been used to treat inflammatory and arthritic disorders in traditional medicine. The present study aimed to investigate the antiarthritic and anti-inflammatory potential of ethanolic leaves extract of J. regia. Arthritis was induced in rodents with Freund's complete adjuvant. J. regia treatment was started on 8th day of arthritis induction and sustained for 20 days. Acute inflammatory models were developed using carrageenan, histamine, serotonin, and dextran. Qualitative and GC-MS analyses were also performed. Arthritis was determined using an arthritis scoring index and histopathological examination of ankle joints. RT-PCR was performed to determine the expression of pro-inflammatory markers (TNF-α, NF-κB, IL-6, IL-1β, and COX-2) and anti-inflammatory IL-4. PGE2 levels were evaluated using an ELISA. Blood and biochemical parameters were also determined. Paw edema was measured using a digital plethysmometer. Treatment with extracts inhibited arthritic development and attenuated paw edema along with all histopathological parameters. The expression levels of pro-inflammatory cytokines and COX-2 were downregulated, while IL-4 was upregulated. PGE2 levels were also reduced in extract-treated groups. Blood and biochemical parameters were nearly normalized in the treatment groups. Both extracts significantly inhibited carrageenan, histamine, serotonin, and dextran-induced paw edema. Qualitative phytochemical screening and GC-MS analysis confirmed that extracts possessed potential medicinal compounds. In conclusion, ethanol and n-hexane extracts of J. regia leaves have immunomodulatory and anti-inflammatory effects that ameliorate experimentally induced arthritis and edema. The inhibition of autacoids may also be one of the mechanisms inducing the immunomodulatory effect. [ABSTRACT FROM AUTHOR]

Arthritis is an acute systemic disease of a joint accompanied by pain. In developed countries, it mainly causes disability among people over 50 years of age. Rheumatoid Arthritis is a type of arthritis that occurs commonly among elders. The incidence of arthritis is higher in females than in males. There is no permanent diagnosis method for arthritis, but if it was identified in the early stages based on the foot pressure, it can be diagnosed before attaining the critical stage of Rheumatoid Arthritis. The analysis and study of arthritis patients were done using design thinking methodology. Design thinking is a problem-solving methodology that is used to find a solution for the identification of the early stage of arthritis. This process consists of five stages follows Empathy, Define, Ideate, Prototype, and Testing. To define the problem statement, the Empathy was done with the arthritis patients to know the difficulties faced by them. This paper proposes a measurement technique of early measurement of arthritis using a non-invasive technique. It helps us to detect arthritis using a foot pressure pad that was designed with piezoresistive material and the feature classification was done using Weka. [ABSTRACT FROM AUTHOR]

Background: Intra-articular impacted fragments (IAIFs) are considered articular surface fragments resulting from impact and compressive forces. The malreduction of IAIFs in posterior malleolar fractures has been associated with talar subluxation and long-term post-traumatic arthritis. In this study, we establish IAIF defect finite element models of different sizes in posterior malleolar fractures and explored how IAIF defects predict the onset of post-traumatic arthritis. Methods: A reliable three-dimensional finite element model of the normal ankle was established. Finite element models with different sizes of IAIF defects were created to calculate ankle joint contact stress. The finite element data were recorded and analyzed. Results: There was a linear relationship between the size of the IAIF defect and MCS with IAIF defects in the posterolateral region. The result of Pearson linear correlation analysis was r = 0.963, P = 0.009. The regression equation was MCS = 0.087*AI + 2.951 (AI, area of IAIF) by simple linear regression analysis. When the IAIF defect was in the posteromedial region, there was also a linear relationship between the size of the IAIF defect and MCS. The result of Pearson linear correlation analysis was r = 908, P = 0.033. The regression equation was MCS = 0.065*AI + 1.841. The MCS was increased mainly in the border of the IAIF defect. Conclusions: A small IAIF defect in the posterior malleolus will result in a high MCS, and the MCS in the posterolateral region is larger than the MCS in the posteromedial region when the size of the IAIF defect is the same. We obtain the regression equation of MCS and area of IAIF defect. This indicates that patients are more prone to post-trauma arthritis when the size of IAIF defects is more than 17.8 mm2 in the posterolateral region and more than 40.9 mm2 in the posteromedial region. Trial registration Retrospectively registered. [ABSTRACT FROM AUTHOR]

Given the state of healthcare in our nation, the unavoidable reality is that, although being a fundamental right, it is not always accessible and, even when it is, it is not always of high quality. According to a poll done by Thomson Reuters in 2011, a large percentage of misdiagnosis occurs in many healthcare institutions, resulting in lasting repercussions and affecting the person's livelihood. Thyroid and Arthritis are two such disorders. While it is believed that 42 million people in India alone suffer from Arthritis, 210 million people worldwide suffer from it in some form or another. In order to determine whether or not a person has Arthritis and Thyroid, our model use the CNN algorithm. It takes image data from users, feeds it into an algorithm, and decides whether the user has Arthritis. When it comes to thyroid detection, the model analyses thyroid scans to see whether there are any nodules present. And correctly infers whether the individual has an abnormal growth around the thyroid gland. [ABSTRACT FROM AUTHOR]

Objective: To determine predictors of work ability and quality of life in a population of older working New Zealanders with and without an arthritis diagnosis. Methods: Participants aged 55‐85 (Mean = 71 years) were drawn from the New Zealand Health, Work and Retirement study. A cross‐sectional survey was conducted with a sample of N = 1154 (n = 696 with arthritis and matched sample (on gender only) of n = 458 without arthritis). Results: Older adults diagnosed with arthritis reported lower levels of work ability and poorer quality of life in comparison with older adults without arthritis. Pain and fatigue were associated with poorer outcomes for all participants. Pain moderated the relationship between arthritis and work ability. Conclusions: An ageing population will lead to an increase in older workers in the workforce. Chronic age‐related diseases such as arthritis may impact older workers' ability to continue to work and enjoy a good quality of life. [ABSTRACT FROM AUTHOR]

Quantitatively and selectively detecting the biomarker of hydrogen sulfide (H 2 S) in arthritis diseases is of great significance for the early diagnosis and treatment of arthritis. Modern medical studies show that H 2 S as a biomarker is involved in the development of inflammation. In this work, a new highly specific fluorescence "turn-on" probe JMD-H 2 S was tailored for H 2 S detection and imaging in drug-induced live cells, zebrafish and mice arthritis models, which utilized pyrazoline molecule as the fluorescence signal reporter group and 2,4-dinitrophenyl ether group (DNB) with strong intramolecular charge transfer (ICT) effect as the H 2 S recognition moiety and fluorescence quenching group. JMD-H 2 S showed a fast response time (<60 s), a large fluorescence response ratio (enhanced ∼20 folds) at I 453 /I 0 , excellent sensitivity toward H 2 S over other analytes, and an outstanding limit of detection (LOD) as low as 25.3 nM. In addition, JMD-H 2 S has been successfully applied for detecting and imaging H 2 S in drug-induced live cells, zebrafish, and mice arthritis models with satisfactory results, suggesting it can be used as a robust molecular tool for investigating the occurrence and development of H 2 S and arthritis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The article presents the case study of a nine‑year‑old boy who was diagnosed with PAPA syndrome at the Department of Pediatrics, Guangzhou First People's Hospital in August 2020. It mentions that he was complaining of multiple joints swelling and pain accompanied by limited mobility in the whole body for 7 years. It reveals that novel interleukin IL‑1 and TNF‑α receptor antagonists have made successful progress in the treatment of PAPA syndrome.

Extrapancreatic manifestations can complicate pancreatic disorders. Pancreatic panniculitis, characterized by subcutaneous fat necrosis, develops in 0.3%-3% of patients with pancreatic disorders. Occasionally, pancreatic panniculitis and polyarthritis occur in the same patient with pancreatic diseases, a rare symptomatic triad known as pancreatitis, panniculitis, and polyarthritis (PPP) syndrome. PPP syndrome is primarily caused by acute or chronic pancreatitis and pancreatic carcinoma. Almost half of the patients with PPP syndrome do not present with gastrointestinal signs, which may lead to a delayed diagnosis of underlying pancreatic disease. The skin and arthritic symptoms may be mistaken for rheumatic diseases. The histological finding of skin lesions is a valuable clue for diagnosing pancreatic diseases. Due to the high mortality rate when PPP syndrome is associated with pancreatic carcinoma, we highlight that the pancreas should be thoroughly examined if a skin biopsy indicates pancreatic panniculitis. [ABSTRACT FROM AUTHOR]