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Objectives To examine the association between sonographic enthesitis with sonographic synovitis and tenosynovitis in PsA patients, and the association between sonographic enthesitis and clinical characteristics. Methods Consecutive PsA patients that fulfilled the ClASsification criteria for Psoriatic ARthritis (CASPAR) were prospectively recruited. Each patient was evaluated by comprehensive clinical and sonographic assessment (greyscale and Doppler), the latter including 52 joints, 40 tendons and 14 entheses [according to MAdrid Sonography Enthesitis Index (MASEI) plus lateral epicondyles] performed by an experienced sonographer blinded to the clinical data. The US enthesitis score was further categorized to inflammatory (hypoechogenicity, thickening, bursitis and Doppler) and structural (enthesophytes/calcifications and erosions) subcategories. Multivariate linear regression models assessed the association between enthesitis and the selected variables. Results A total of 158 PsA patients [mean (s. d.) age 52.3 (13) years, 88 (55.7%) females] were analysed. Multivariate linear regression analyses showed a significant association between sonographic enthesitis and sonographic synovitis (β = 0.18, P  = 0.008) and between sonographic enthesitis and sonographic tenosynovitis (β = 0.06, P  = 0.02). These associations were derived from the enthesitis inflammatory subcategory of the MASEI (P   <  0.05). Associations between enthesitis and synovitis were also demonstrated on the level of the elbow, knee and ankle joints (P   <  0.05). In addition, sonographic enthesitis was significantly associated with older age, male sex, swollen joint count, CRP level and physical occupation. Conclusions Sonographic enthesitis is associated with sonographic synovitis and tenosynovitis. The severity of sonographic enthesitis may represent a marker for inflammatory activity in other musculoskeletal domains. [ABSTRACT FROM AUTHOR]

Objectives To report the discrepancies and agreements between US, MRI and radiography of the hand in PsA, and to compare the sensitivity and specificity of US and radiography to MRI as the gold standard imaging study in PsA. Methods All of the 100 prospectively recruited consecutive PsA patients underwent clinical assessment and concomitant radiographic, US and MRI studies of the MCP, PIP and DIP joints of one hand. Synovitis, flexor tenosynovitis, extensor paratenonitis, erosions and bone proliferations were identified and scored. All readers were blinded to clinical data, and agreement was calculated based on prevalence-adjusted bias-adjusted kappa (PABAK). Results The prevalence of synovitis, flexor tenosynovitis, extensor paratenonitis and erosions was similar for US and MRI, while that of bone proliferation was significantly increased in US and radiography compared with MRI (P   <  0.001). The absolute agreement between US and MRI was good-to-very good for synovitis (85–96%, PABAK = 0.70–0.92), flexor tenosynovitis (93–98%, PABAK = 0.87–0.96) and extensor paratenonitis (95–98%, PABAK = 0.90–0.97). Agreement between US, MRI and radiography was 96–98% (PABAK = 0.92–0.97) for erosions and 71–93% (PABAK = 0.47–0.87) for bone proliferations. Sensitivity of US with MRI as gold standard was higher for synovitis (0.5–0.86) and extensor paratenonitis (0.63–0.85) than for flexor tenosynovitis (0.1–0.75), while the specificity was high for each pathology (0.89–0.98). Conclusion There is very good agreement between US and MRI for the detection of inflammatory changes in finger joints in PsA. US, radiography and MRI have a good-to-very good agreement for destructive changes. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the effect of presurgical symptoms characteristic of fibromyalgia on the postsurgical outcome of patients undergoing spinal surgery. Methods. In this observational cohort study, participants were patients scheduled for spinal surgery, including cervical or lumbar laminectomy and foraminectomy. Presurgical evaluation included physical examination and manual dolorimetry. Questionnaires included the widespread pain index (WPI), symptom severity scale (SSS), and SF-36. Postsurgical evaluation performed at 10-12 weeks included questionnaires, physical examination, and dolorimetry. Results. Forty patients (21 male, 19 female) were recruited. Four patients (10%) fulfilled American College of Rheumatology (ACR) 1990 fibromyalgia; nine patients fulfilled 2010 criteria (22.5%). Overall, a significant 34% reduction in WPI was observed postsurgically (P< 0.01), but no significant change was observed in SSS. Comparing outcomes for patients fulfilling and not fulfilling fibromyalgia criteria, fibromyalgia syndrome (FMS)-negative patients experienced highly significant reductions of both SSS and WPI (-50.1% and -42.9%, respectively, P< 0.01), while FMS-positive patients experienced no reduction of SSS symptoms and only a marginally significant reduction in WPI (-20.3%, P50.04). A significant negative correlation was observed between results of presurgical WPI and change in physical role functioning SF-36 component postsurgically. A significant negative correlation was observed between presurgical SSS and change in composite physical functioning SF-36 component. Regression analysis demonstrated a difference in trend between FMS-positive and FMS-negative patients regarding postop changes in SSS, as well as a difference in trend regarding the general health role limitation due to emotional problems and pain components of the SF-36. Conclusions. Fibromyalgia symptoms were highly prevalent among patients scheduled for spinal surgery. A negative correlation was observed between presurgical severity of fibromyalgia symptoms and components of postsurgical SF-36. Patients with symptoms typical of fibromyalgia may have a less favorable outcome after spinal surgery. The clinical utility of surgical intervention in such patients should be carefully evaluated, and treatment specific for fibromyalgia might be considered before embarking on a surgical course. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive dysfunction is one of the criteria for the diagnosis of fibromyalgia (FM) and is typically based on self-report questionnaires such as the Symptom Severity Scale. However, recent studies have shown that there is no correlation between these subjective measures of cognitive dysfunction and more lengthy objective measures of cognitive functioning. This points to the need for a briefer valid evaluation tool for cognitive dysfunction in FM. The aim of this study is to examine whether the Montreal Cognitive Assessment (MoCA) test is a valid measure of cognitive assessment in FM patients, by comparing it to a comprehensive computerised cognitive assessment battery., Methods: Sixty-two FM patients (55 women, 7 men, mean age = 46.17 years, sd=12.56) were administered the MoCA and a computerised cognitive assessment battery. FM symptoms were assessed on the Fibromyalgia Impact Questionnaire (FIQ), the Widespread Pain Index (WPI), the Symptom Severity Scale (SSS), and the Beck Depression Inventory (BDI-2). Patient effort was controlled on the TOMM (Test of Memory Malingering)., Results: Moderate positive correlations were found between the MoCA and the computerised cognitive scores as follows: Global Cognitive Score (r=0.493**, p=0.00), Memory Index Score (r= 0.384**, p=0.002), Executive Function Index Score (r=0.461**, p=0.00), Attention Index Score (r=0.310*, p=0.016), Information Processing Speed Index Score (r=0.435**, p=0.001), and Motor Skills (r=0.406**, p=0.002)., Conclusions: The MoCA is an acceptable cognitive screening test for the cognitive evaluation of FM patients.

Introduction: Chronic pain is an issue of increasing health concern, with a negative impact on suffering patients, their families, and society since it is contributing to high health care costs and loss of productivity. Fibromyalgia is one of the most common causes of chronic pain, especially in women, and is associated with several comorbidities, leading to both increased levels of distress as well as decreased function. Obesity is another chronic disease, with increasing prevalence around the world, associated with increasing morbidity and mortality. In their study published in the present issue of Harefuah, Blokh Kerpel et al found a strong link between these two epidemics - fibromyalgia and obesity. This association contributes to our understanding regarding the epidemiology and pathogenesis of fibromyalgia. Obesity also negatively affects the course of fibromyalgia. Obese patients with fibromyalgia experience more pain, are more depressive, have reduced mobility and function and use more medications. Moreover, feasibility and efficacy of treatment interventions is challenging, especially in terms of physical activity - the mainstream of fibromyalgia treatment - which is severely reduced in obese patients. Optimal treatment for obese patients with fibromyalgia must address these issues.

Objectives: The presence of serological markers associated with inflammatory bowel disease (IBD) has been studied in spondyloarthritis with conflicting results. The anti-glycan antibodies: anti-laminaribioside, anti-chitobioside, and anti-mannobioside carbohydrate antibodies (ALCA, ACCA, and AMCA) are serological markers previously associated with IBD. We aim to investigate the prevalence of these antibodies in spondyloarthritis in comparison with rheumatoid arthritis (RA) patients., Methods: Serum samples were obtained from consecutive patients with spondyloarthritis and were compared to RA and healthy controls. Anti-glycan antibodies - ALCA, ACCA and AMCA - were assessed using ELISA (Glycominds Ltd, Israel). Demographic characteristics, family history, disease pattern, skin evaluation (for PsA), disease activity and a questionnaire for gastrointestinal symptoms were recorded., Results: Seventy patients were recruited: 36 ankylosing spondylitis (AS) and 28 psoriatic arthritis (PsA). No difference in ALCA or AMCA levels was observed between all the study groups. Significantly higher levels of ACCA were observed in RA patients, compared to healthy controls (p=0.002). One or more of the anti-glycan antibodies was found in 16.7%, and 3.6% of patients with AS and PsA, respectively, compared to 7.3% in healthy controls and 27% in RA (p=0.09). No correlation was found between the presence of anti-glycan antibodies and gastrointestinal symptoms., Conclusions: Our data fail to show an increased prevalence of anti-glycan antibodies in AS or PsA patients. ACCA were found to be significantly higher in RA patients than in controls, and may serve as an inflammatory biomarker. The present results do not support a role for antiglycan antibodies as biomarkers for spondyloarthritis.

Unlabelled: Fibromyalgia represents the tip of the iceberg of chronic pain in the general population. We have attempted to estimate the prevalence of fibromyalgia in the Israeli population, using the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ), an instrument previously utilised in several European countries., Methods: The LFESSQ-4 screens for widespread pain, and the LFESSQ-6 for widespread pain and chronic fatigue. The LFESSQ was administered via telephone to a sample of 1019 individuals. To estimate the positive predictive value (PPV) of LFESSQ-4 and LFESSQ-6, this questionnaire was submitted to a sample of rheumatology outpatients (n=76), who were examined to confirm or exclude fibromyalgia according to the 1990 criteria. The prevalence of fibromyalgia in the general population was estimated by applying the PPV to community subjects., Results: In the community survey, 5.1% and 3.9% of individuals screened positive for the LFESSQ-4 and LFESSQ-6, respectively. The point prevalence of FMS in the Israeli general population was 2.6% (95%CI 1.7-3.4) when using LFESSQ-4 and 2.0% (95%CI 1.3-2.7) when using the LFESSQ-6 criteria., Conclusions: The prevalence of the fibromyalgia syndrome in the Israeli population is considerable and constitutes a significant health care issue. The prevalence is similar to that observed in other western populations. Based on this tool, over 25% of fibromyalgia cases appear to be among males, a proportion higher than generally appreciated.