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Ultrasound elastography (UE) is a non-invasive imaging method that allows the assessment of tissue elastic property. Different UE techniques are currently available (i.e. strain UE and acoustic radiation force impulse UE), with several potential clinical applications. Recent studies investigated the role of UE in two systemic rheumatic diseases and psoriasis. This research added interesting information to the already known applications of UE in the assessment of tendinopathies. In SS, acoustic radiation force impulse UE has shown a potential role in the diagnosis of the disease, with lower sensitivity than and similar specificity to salivary gland histology. In SSc, a potential use of UE in screening pre-clinical disease has been reported. In psoriasis, the use of strain UE in evaluating treatment response has been highlighted. UE is a promising tool in rheumatology, with a potential role in the evaluation of various tissues and pathologies. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study is to describe the epidemiologic characteristics of a cohort of patients with early arthritis and to identify the particularities that may help to identify the patients with early rheumatoid arthritis (ERA) from this cohort. Methods. 73 patients with ERA or early undifferentiated arthritis (EUA) were enrolled. Patients were recruited from those who presented in the “Early Arthritis Research Center” of “Dr. I. Cantacuzino” Hospital with inflammatory arthritis of one or more joints, lasting for at most 12 months. Results. 73 patients were included in this study, 44 females (60.3%) and 29 males (39.7%). 47 patients (64.3%) fulfilled the 2010 EULAR/ACR criteria for RA. The mean age of patients enrolled in the study was 49.81±15.93 years. The mean symptom duration was 3.39±3.42 months. The predominant form of presentation was polyarticular. While the values of acute phase reactants are comparable between groups and the differences are not significant (p>0.05 - Mann-Whitney test), in case of immunologic markers there is a difference represented by significantly higher values in the group with ERA (p<0.001). The NTJ and NSJ is significantly higher in patients with ERA (p<0.001). The values of VASd are significantly higher than that of VASp (p<0.001). CDAI and SDAI identified more patients with high disease activity than DAS28. Conclusion. It was observed that there is a high degree of variation between results reported in different studies performed on cohorts of patients with early arthritis and we believe it is important to know the particularities of patients treated by one to improve clinical practice. The patients with ERA tended to have higher values of the parameters evaluated than the patients with EUA. [ABSTRACT FROM AUTHOR]

Background. In rheumatoid arthritis (RA), prompt diagnosis and initiation of disease-modifying treatment during the first months after disease onset - a period called “window of opportunity” - is significantly superior to the delayed start of the same therapy. Clinical remission is more frequently obtained in patients with a disease duration no longer than 4 months and is the main aim of the treatment, therefore the “treat to target” (T2T) and “tight control” strategies were proposed. Objective. The aim of this study is to evaluate the therapy used for patients with early RA (ERA) and the impact of this medication on the clinical outcomes at 12 months after the first evaluation. Methods. Patients with early arthritis who were referred to the Early Arthritis Research Center of “Dr. I. Cantacuzino” Hospital between 2010-2014 and who fulfilled the 2010 EULAR/ACR Classification Criteria for RA (and who did not satisfy classification criteria for other inflammatory rheumatologic diseases) were enrolled. Only patients who received treatment with Methotrexate (MTX) associated or not with corticosteroids (CS) and patients who fulfilled the classification criteria for RA but did not received any DMARDs therapy were enrolled. Results. Forty-three patients were enrolled in the study, 62.8% females, mean age 55.47±13.71 years, median (interquartile range) DAS28 5.07 (4.31-5.60), SDAI 29.02 (20.92-34.61). At the first presentation, 40 patients (93.0%) received treatment with Methotrexate (MTX) in doses ranging from 5 mg/week to 20 mg/week, with a mean dose of 11.16±4.47 mg/week, the most frequently used doses ranging from 10 mg/week to 15 mg/week. 26 patients (60.5%) received corticosteroids (CS), either oral or intra-articular. During the study both the total number of patients receiving MTX and the mean dose of MTX increased, while the number of patients receiving CS decreased and at the end of the study only low-dose oral CS were still administered in 8 patients. At 12 months, median (interquartile range) DAS 28 was 1.77 (1.43-3.16), SDAI 3.58 (2.32-11.82). The evolution under treatment assessed by DAS28 and SDAI wasn't significantly different between patients who received, at baseline, MTX in association with CS (mean value: ΔDAS28=-2.58±1.72, ΔSDAI=-20.44±16.49) and those who received MTX monotherapy (mean value: ΔDAS28=-2.91±1.17, ΔSDAI=-21.80±9.89) (p>0.05). There was no significant difference in change from baseline of DAS28 and SDAI at 12 months between patients who received low-dose oral CS and those who received intermittent intra-articular CS (p>0.05). Conclusions. Treatment with MTX and/or CS led to clinical and laboratory improved outcomes at 12 months of follow-up. There was no significant difference regarding long-term outcomes between patients who received lowdose oral CS and those who received intra-articular CS. As this study was performed on a relatively small number of real-life patients with ERA, the results obtained should be validated on larger cohorts of patients. [ABSTRACT FROM AUTHOR]

Objective. Our aim was to investigate whether two ERAP1 gene variants, rs30187 and rs27044, infl uence the clinical characteristics of ankylosing spondylitis (AS) (the age of onset and the type of articular manifestations - axial or mixed) in Romanian patients. Methods. We studied 94 AS patients and 139 healthy controls. The method used for genotyping the two nonsynonymous single nucleotide polymorphisms (SNPs) was real-time polymerase chain reaction. Association tests were carried out using PLINK 1.07 software. We analyzed separately the subgroups of AS patients with early onset (age <30 years) and late onset (age > 30 years), as well as the subgroups of patients with axial manifestations and mixed manifestations (axial and peripheral). Results. Signifi cant association between ERAP1 polymorphisms and AS is only present for patients who experienced an early onset (p = 0.04 for rs30187 and p = 0.007 for rs27044) and not for those with late onset (p = 0.32 for rs30187 and p = 0.29 for rs27044). Polymorphism rs30187 is associated only with the axial form of AS (p = 0.02), while rs27044 is associated only with the mixed form of the disease (p = 0.02) Conclusions. Our fi ndings demonstrate a consistent association between the studied ERAP1 gene SNPs and certain phenotypic characteristics of AS, suggesting that these gene variants may infl uence the AS onset and the presence of axial or mixed manifestations of AS. [ABSTRACT FROM AUTHOR]

Ankylosing spondylitis (AS) is a chronic infl ammatory arthritis which involves mainly the spine and the sacroiliac joints, but also the peripheral joints and nonarticular structures. IL-12 and IL-23 are heterodimeric cytokines sharing a common p40 subunit. Studies showed than IL-12 is essential for Th1 differentiation while IL-23 promotes a particular subset of T cells characterized by IL-17 production, called Th17. Since the association of IL-23R with AS was reported, the scientifi c interest has focused on identifying new single nucleotide polymorphisms (SNPs), present in the coding genes for IL-12/IL-23 subunits and their receptors, that increase the susceptibility for AS. Another point of interest for researchers was to investigate if the identifi ed gene variants modify the gene expression of the respective interleukins and/or their receptors, whether that refers to their mRNA expression, their serum levels or the expression of the receptors on the surface of T cells. Given the increasing amount of data that suggests the pivotal role of the IL-23/Th17 axis in AS pathophysiology, new promising therapies, designed to interfere with these pathways, are now in development. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the prevalence of ultrasound-detected tendon abnormalities in healthy subjects (HS) across the age range., Methods: Adult HS (age 18-80 years) were recruited in 23 international Outcome Measures in Rheumatology ultrasound centres and were clinically assessed to exclude inflammatory diseases or overt osteoarthritis before undergoing a bilateral ultrasound examination of digit flexors (DFs) 1-5 and extensor carpi ulnaris (ECU) tendons to detect the presence of tenosynovial hypertrophy (TSH), tenosynovial power Doppler (TPD) and tenosynovial effusion (TEF), usually considered ultrasound signs of inflammatory diseases. A comparison cohort of patients with rheumatoid arthritis (RA) was taken from the Birmingham Early Arthritis early arthritis inception cohort., Results: 939 HS and 144 patients with RA were included. The majority of HS (85%) had grade 0 for TSH, TPD and TEF in all DF and ECU tendons examined. There was a statistically significant difference in the proportion of TSH and TPD involvement between HS and subjects with RA (HS vs RA p<0.001). In HS, there was no difference in the presence of ultrasound abnormalities between age groups., Conclusions: Ultrasound-detected TSH and TPD abnormalities are rare in HS and can be regarded as markers of active inflammatory disease, especially in newly presenting RA., Competing Interests: Competing interests: There are no declared competing interests from authors except the following: CC declared grants from NIHR Versus Arthritis, Lilly sponsored EULAR conference travel, Modern Biosciences payment as DSM committee member, Roche consultancy fee and Novartis sponsored writing of one medical paper. KI declared a Mitsubishi-Tanabe research grant for RA; Abbvie, Eli Lilly, Mitsubishi-Tanabe, Bristol-Myers-Squib and Novartis speaker’s fees; and participation on a DSM board for Abbvie, Eli Lilly and Mitsubishi-Tanabe. RK declared support from Abbvie, Roche, Novartis and UCB with payments for travel to meetings/lectures, presentations, speakers’ bureaus, manuscript writing/educational events., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Objective: To evaluate the discriminatory ability of ultrasound in calcium pyrophosphate deposition disease (CPPD), using microscopic analysis of menisci and knee hyaline cartilage (HC) as reference standard., Methods: Consecutive patients scheduled for knee replacement surgery, due to osteoarthritis (OA), were enrolled. Each patient underwent ultrasound examination of the menisci and HC of the knee, scoring each site for presence/absence of CPPD. Ultrasound signs of inflammation (effusion, synovial proliferation and power Doppler) were assessed semiquantitatively (0-3). The menisci and condyles, retrieved during surgery, were examined microscopically by optical light microscopy and by compensated polarised microscopy. CPPs were scored as present/absent in six different samples from the surface and from the internal part of menisci and cartilage. Ultrasound and microscopic analysis were performed by different operators, blinded to each other's findings., Results: 11 researchers from seven countries participated in the study. Of 101 enrolled patients, 68 were included in the analysis. In 38 patients, the surgical specimens were insufficient. The overall diagnostic accuracy of ultrasound for CPPD was of 75%-sensitivity of 91% (range 71%-87% in single sites) and specificity of 59% (range 68%-92%). The best sensitivity and specificity were obtained by assessing in combination by ultrasound the medial meniscus and the medial condyle HC (88% and 76%, respectively). No differences were found between patients with and without CPPD regarding ultrasound signs of inflammation., Conclusion: Ultrasound demonstrated to be an accurate tool for discriminating CPPD. No differences were found between patents with OA alone and CPPD plus OA regarding inflammation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)