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Objectives: Nail unit is one of the targets of ultrasound (US) assessment. We aimed to compare ultrasound parameters of clinically normal nail unit in psoriatic arthritis (PsA) patients with healthy controls (HC) and evaluate their correlations with disease activity. Methods: This was a cross‐sectional study including patients with PsA and matched HC. Tender (TJC) and swollen joint count (SJC), Psoriasis Area and Severity Index (PASI), and Disease Activity in Psoriatic Arthritis (DAPSA) were collected in PsA patients. Patients underwent US assessment of fingernails with a study of morphological changes and measurement of the thickness of nail bed (NBT), nail plate (NPT), and adjacent skin (ST). Correlation between nail unit parameters and disease activity was studied. Results: We evaluated 22 PsA patients (219 nails) and 21 HC (210 nails). Mean DAPSA was 21.56 ± 14.36 and mean PASI was 2.19 ± 3.8. PsA patients had more US morphological changes than HC (16.89 vs 3.33%, P =.03). NPT comparison between identical fingernails of PsA and HC did not reveal significant difference. However, NBT was significantly higher in HC (1.77 vs 2.07 mm, P =.027) as well as ST (2.26 vs 2.59 mm, P =.003). TJC and ST were positively correlated (r =.46, P =.03). No correlation was noted between disease activity scores and NPT, NBT, or ST in PsA patients. In biologic parameters, ESR was negatively correlated with ST (r = −.41, P =.05). Conclusions: Nail bed and adjacent skin US morphological changes were contributive to distinguish psoriatic from healthy nails. Adjacent skin thickness measurement was positively correlated with TJC and ESR, suggesting that it could be used as an indicator of disease activity in PsA. [ABSTRACT FROM AUTHOR]

Introduction: Foot problems are very common in rheumatoid arthritis (RA). Podiatric intervention through therapeutic education of RA patients on the different potential foot problems could improve patients' knowledge and management of their foot problems. This study aimed to evaluate the knowledge of RA patients on podiatric problems related to their illness and foot care practices. Methods: This was a cross‐sectional study including patients diagnosed with RA and aged older than 18 years. Sociodemographic data, disease characteristics, and therapeutic data were collected. RA foot problems knowledge and foot care practice were assessed using a questionnaire combining questions developed from the literature search and a pretested validated questionnaire. Results: Overall, 103 patients were included of whom 94 were female. The mean age was 56 years (±10 years) and the mean disease duration was 15 years (±10 years). Over 77% of patients reported never having received foot‐health‐related education. With regard to their knowledge about RA foot involvement, patients were aware that RA can affect the feet similarly to the hands (83%), lead to deformation of the foot (86%), lead to walking difficulties and falling (68%), and produce skin lesions of the foot (31%). Regarding participant's knowledge of appropriate footwear, 65% agreed that it would be beneficial to wear quality standard sports shoes. However, less than one‐third of patients know the podiatrist's skills. Conclusion: Our study showed an awareness of the repercussions of RA on feet but a lack of knowledge on proper foot care, thus identifying a need for foot health therapeutic education. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to screen the presence of silent myocardial ischaemia, in established rheumatoid arthritis (RA) patients, using a stress test then to evaluate its association with the disease activity and the cardiovascular (CV) risk factors and Heartscore. Methods: It is a transversal study in a rheumatologic centre in Tunisia. One hundred three RA patients, asymptomatic for CV diseases, were submitted to a stress test. Demographic data, CV risk factors and disease characteristics were assessed and risk factors of silent myocardial ischaemia in RA patients were identified. Results: There were 103 patients (sex‐ratio = 0.3) with a mean age of 53 ± 10 years. The evaluation of the disease activity showed that the mean Disease Activity Score in 28 joints C‐reactive protein, Clinical Disease Activity Index and Simplified Disease Activity Index were 3.9 ± 1.38, 17.17 ± 11.4 and 33.39 ± 26, respectively. The ischaemic ratio (CT/HDL) revealed that 42% of patients had a moderate to high myocardial ischaemic risk. HeartSCORE was high in 35% of cases. A silent myocardial ischaemia in the stress test was found in 11 patients (10.6%) and was associated with male sex (p = 0.03), advanced age (p = 0.04), erosive character (p = 0.05), the advanced age of the RA diagnosis (p = 0.01) and the ischaemic ratio (p = 0.05). No relationship was found with the majority of traditional CV risk factors nor with disease activity variables. Conclusion: Our results corroborated the hypothesis that the stress test could reveal subclinical CV dysfunction and supported the utility of the Heartscore as a screening tool. [ABSTRACT FROM AUTHOR]

Background: Psoriatic arthritis (PsA) is a multifaceted inflammatory disease that has a strong negative impact on the quality of life (QoL) of patients. The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire was the first disease‐specific patient‐derived instrument developed to measure the QoL in patients with PsA. Our objective was to translate the PsAQol into Arabic language and evaluate its reliability and validity in patients with PsA. Methods: This was a cross‐sectional study including patients with PsA. A clinical and biological assessment of the patients was performed at inclusion. The translation of the original PsAQoL into Arabic was performed by a professional bilingual and lay panel. Eight patients were interviewed to assess face and content validity. A separate sample of PsA patients (n = 30) were invited to participate in a test‐retest postal study in order to investigate reproducibility and construct validity. One week separated the two administrations. The Arabic version of Health Assessment Questionnaire (HAQ) was used as a comparator instrument for convergent validity. Results: Face and content validity were satisfactory. The Arabic version of the PsAQoL was found to be relevant, understandable and easy to complete in only a few minutes. One item was excluded (item 16). It had no correlation with either the other 19 items or the total score of PsAQol. The Arabic PsAQol had excellent internal consistency (Cronbach's a = 0.926), and test‐retest reliability (r = 0.982). There was a positive correlation between the total score of the PsAQoL and the Arabic version of HAQ (Spearman's r = 0.838, p < 10−3). Exploratory factor analysis had extracted two factors explaining 55% of the total variance. Conclusion: Nineteen items were selected to compose the Arabic version of PsAQoL, which was found to be relevant and understandable and has excellent reliability and construct validity. The new measure will be a valuable new tool for use in routine care for patients' assessment. [ABSTRACT FROM AUTHOR]

Background: The objective of the study was to assess clinical and imaging features of rheumatoid arthritis associated with atlantoaxial dislocation (RA‐AAD) in comparison to RA without AAD (RA‐C) and to identify the associated factors to AAD. Methods: This was a retrospective comparative study including RA patients over 18 years old. The control group of RA‐C was matched according to age (±2 years), gender, and RA duration (±2 years). General data, RA characteristics, AAD features, and treatment modalities were recorded. Statistical analysis was performed to determine the predictive factors of AAD. Results: A total of 120 patients were included (78 RA‐AAD and 42 RA‐C); sex‐ratio was 0.15. Mean age was 58.55 ± 9.14 years (RA‐AAD) versus 60.43 ± 10.78 years (RA‐C), (p = 0.31). Regarding RA features, RA‐AAD patients have significantly a higher rheumatoid factor (RF) rate (p = 0.002), extra‐articular manifestations (p = 0.009) especially osteoporosis (p < 10−3), eye involvement (p = 0.02), coxitis (p < 0.0001), Disease Activity Score (DAS28) (p < 10−3), and global health status scale (HAQ) (p = 0.003). X‐ray analysis showed pathologic PADI (<14 mm) in 51.6% of cases. The AADI was pathological (>3 mm) in 100% of patients with the following distribution: 67.9% between (3–6 mm) and 23.3% between (6–9 mm). Atlantoaxial dislocation (AAD) was presumed anterior (85.4%), lateral (7.3%) and rotatory (7.3%). The abnormalities observed on magnetic resonance imaging (MRI) were: C1–C2 synovitis (61%), confirmed AAD (34.1%) and basilar impression (4.9%). AAD diagnosed by cervical MRI was anterior in 89.8% of cases, lateral (5.3%) and with a double ascending and anterior component in 4.9% of cases. An immobilisation with a type C4 cervical collar was indicated for all the patients and five of them had boluses of corticosteroid (methylprednisolone 1 g/day) for three consecutive days. C1–C2 arthrodesis by trans‐articular screwing was performed in four patients with neurological signs or pathological measurements on cervical MRI. The outcome was favourable in 100% of cases after surgical treatment with improvement in neck pain and neurological condition within a mean decline of 4 ± 3 years [1–7]. Multivariate analysis identified coxitis, osteoporosis, high baseline DAS28, and a high rate of RF positivity as predictive factors of AAD. Conclusion: Our results confirmed that predictive factors of AAD were related to higher disease activity and structural damage. These modifiable factors may be prevented by tight control, early treatment, and educating RA patients to improve treatment adherence. [ABSTRACT FROM AUTHOR]

Background: Foot function is usually assessed using self‐reported outcome measures which remain subjective in patients with rheumatoid arthritis (RA). Physical performance tests were recommended for functional assessment in lower limb osteoarthritis. However, foot function assessment's guidelines in RA are lacking. We aimed to investigate the correlation between a self‐reported outcome measure and two performance‐based physical tests for assessing foot function in RA patients. Methods: A cross‐sectional study was performed over 7 months' period including RA patients. We used Rheumatoid and Arthritis Outcome score (RAOS) as a self‐reported functional tool. Physical performance tests were 4‐min walk test (4‐MWT) and Timed up and go test (TUGT). Results: Fifty RA patients were included with 96% females and a mean age of 54.7 ± 10.4 years. Foot involvement occurred since the diagnosis of RA in 36% of patients. Foot pain was reported by 68% of patients (48% forefoot), and foot stiffness in 46% of patients. Skin lesions of the feet were found in 78% of patients, 90% had foot deformities and 56% had inflammatory disorders of feet. Radiographic lesions were found in 94% of patients. The most impaired RAOS subscales were Sports and Recreation and Quality of life. Poor physical‐based performance was found in 34% of RA patients according to 4‐MWT, in 42% of RA patients according TUGT, and in 46% of patients based on at least one performance test. RAOS was negatively correlated to the 4‐MWT and positively correlated in the subscales pain, other symptoms, activities of daily living, and Sport/Rec of the RAOS. Poor performance‐based physical tests were significantly associated with advanced age, sedentary lifestyle, higher disease activity score and impaired functional status. Foot‐related parameters significantly associated with poor performance‐based physical tests were: foot pain, foot deformity and inflammatory disorders. Multivariate analysis identified foot deformities and higher functional impairment as predictive factors for lower gait speed (4‐MWT) and older age and higher functional impairment for higher duration of TUGT. Conclusion: RAOS was significantly associated with performance‐based physical function. In the era of connected technologies, these results encourage the regular assessment of rheumatoid foot function by the RAOS score through a connected programme using wearable trackers. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease, which is associated with an increased risk of cardiovascular disease (CVD). Metabolic syndrome (MetS) is a set of factors that increase the risk of CVD, and recent studies suggested an increased prevalence of MetS in RA more than in general population. Aim: The aim of this study is to determine the prevalence of MetS in patients with RA and to evaluate its association with the disease activity and inflammation parameters. Then, to evaluate other cardiovascular risk factor and HeartSCORE Eular 2015 and its relation with the MetS. Methods: It is a cross-sectional study of 103 RA patients assessing the prevalence of the MetS in RA patients. MetS was defined according to the National Cholesterol Education Program/Adult Treatment Panel III guidelines. RA disease activity was assessed with CDAI, SDAI and DAS28 scores. Independent risk factors for MetS in RA patients were identified by logistic regression. Results: The mean age was 53 ± 10 years. The sex ratio (Male/female) was 0.3. About half of patients (45%) had moderate disease activity with a mean DAS28 CRP score of 3.9±1.38. Prevalence of MetS was 38.8% in RA patients. MetS was associated with higher age (P=0.03), late onset disease age (P=0.01), family history of CVD (P=0.016), current use of corticoid (P=0.01) and menopause status (P=0.006). However disease activity, inflammation or treatment were not associated with MetS. Conclusions: MetS in RA patients was not associated with inflammation and disease activity. [ABSTRACT FROM AUTHOR]

Background: Calcium-pyrophosphate-dihydrate-disease (CPPD) is a crystal-induced arthropathy. The lumbar-spinal involvement is rare and often under-diagnosed. This study aimed to report the case of a lumbar spine CPPD involvement and to perform a systematic review of clinical, imaging features of lumbar involvement in CPPD patients, and treatments that have been implemented. Methods: This systematic review was conducted in accordance with the Preferred-Reporting-Items-for-Systematic-Reviews and Meta-Analyses (PRISMA) guidelines. Results: One hundred and sixty-seven articles met the search criteria using electronic databases searches. We retained 28 articles (20 case reports, 2 case series, 1 family survey, 4 retrospective studies, and 1 prospective study) involving a total of 62 patients. The age ranged between 39 and 89 years old. Among patients with lumbar spine CPPD, 32 were women. The duration of symptoms varied between one day and 8 years. The affection has been discovered during back pain in most cases. In 5 studies, the diagnosis was made on histological specimens of patients operated on for another pathology. X-ray showed calcifications in 2 cases. CT-scan detected calcium deposit in 7 cases. MRI showed lesions going from the increased signal of the disk, to calcified or not-cystic lesion of the facet joints, an intramedullary mass mimicking a schwannoma. Histological examination established the diagnosis of CPPD in 21 patients in all studies. Medical treatment included NSAIDs, Colchicine, Interleukin-1-receptor-antagonist, and antibiotics. Surgery was performed on 13 patients and allowed to establish the histological diagnosis. Conclusion: In the case of inflammatory back pain in elderly subjects, without an infectious gateway, diagnosis of CPPD should be considered, especially for patients with a history of spinal surgery or degenerative radiography changes. CT scan is more sensitive than conventional radiographs. The discovertebral biopsy is the Gold-Standard and should be performed whenever the diagnosis was uncertain. Treatment includes the medical and surgical components. [ABSTRACT FROM AUTHOR]