The diagnosis of hip dysplasia has developed very differently in different countries over the last few decades. The development and current situation in Switzerland is described in this paper. In the meantime, early diagnosis by means of Graf hip sonography, corresponding to screening, has been established, although it varies from region to region. The training system for examiners is also clearly regulated. The massive reduction in costly treatments and operations documents the success of the efforts made in Switzerland.
Aim: The aim of the present study is to conduct interobserver and intra-observer validation of computer analysis of static ultrasound images of entheseal territories of the Achilles and distal patellar tendons.
Methods: Three rheumatologists with varying levels of experience underwent training in the use of ImageJ software for the analysis of 384 pairs of ultrasound images (long and short axis) from recorded studies of the Achilles and patellar tendons of both spondyloarthritis (SpA) patients and controls. Intra-observer and interobserver tests were conducted by calculating the differences in measurements of the same image at two different times by the same observer and by two different observers assessing the same image. The measurements included the area of analysis, the mean grayscale intensity, and the dispersion of grayscale intensity.
Results: In the intra-observer test, no measurement showed a difference greater than 15%, ranging from 4.10% to 14.14%. In the interobserver test, no measurement exhibited a difference greater than 16%, ranging from 7.96% to 15.87%. The differences detected were evenly distributed among observers in both the intra-observer and inter-observer tests. Higher differences were detected in the analysis of images obtained from patient studies compared to control studies in almost all measurements.
Conclusions: Whether analyzing control or patient ultrasound images of Achilles and patellar tendons, the intra-observer and interobserver agreement of computer-based analysis of static ultrasound images is more than acceptable and predominantly excellent.
Since 1980, when Professor Reinhard Graf developed a novel technique, sonography of the infant hip has played a prominent role in the early diagnosis of developmental dysplasia of the hip (DDH). Brazil is a vast country, and disparities exist among regions and between the public and private health systems. In addition, healthcare professionals often have limited knowledge of DDH, and patients need to be referred to larger urban centers for definitive diagnosis and appropriate treatment. These reasons, and more, may hinder the early diagnosis of DDH. Following the successful implementation of similar neonatal screening programs for other conditions in Brazil, developing a screening program for DDH in Brazil is imperative. Such a program should consider training professionals to use Graf’s technique as a diagnostic procedure. It is recommended that more studies be conducted in every region of the country to provide a broader understanding of the current role of sonography in the screening and diagnosis of DDH in infants in Brazil.
Aim: Osteoporosis (OP) is caused by imbalanced bone remodelling homeostasis. It is highly prevalent, especially in post-menopausal women, resulting in high risk of fracture and morbidity. Mesenchymal stromal cells (MSCs) are osteoblast progenitors, and orchestrate the function of surrounding cells including osteoblasts. Understanding MSC phenotype and function is therefore critical in discerning the aetiology of OP and developing superior therapies. Currently, adequate long-term therapeutic strategies are not available.
Methods: Bioinformatic analysis of ribonucleic acid sequencing (RNA-seq) data revealed differential expression of genes primarily related to osteogenic differentiation and proliferation, followed by confirmatory in vitro analysis.
Results: This study identified novel and previously proposed targets for therapeutic intervention in OP. Functional assessment demonstrated reduced MSC number and osteogenic capacity associated with OP. Proliferation was not affected but OP was unexpectedly associated with a reduction in MSC adipogenic differentiation capacity, correlating with donor age.
Conclusions: These data indicate specific targets for further studies of future treatments for OP, including the assessment of modified MSCs as therapeutics. Advances in this area may contribute to reducing fracture-associated morbidity and mortality, and improving quality of life for the 200 million people living with OP globally.
Background: The United Kingdom (UK) currently employs a selective screening system for developmental dysplasia of the hip (DDH). Despite this, late presentation rates remain high. The aim of this study was to systematically review the available literature to gain an understanding of screening practices throughout the UK.
Methods: A systematic review was conducted. Studies reporting DDH screening methods from the UK were included. The primary outcome measure was the method of ultrasound and clinical screening. Secondary outcomes were the treatment rate and late presentation rate. A narrative analysis was undertaken, as meta-analysis was felt to be inappropriate due to the differences between included studies.
Results: Nine studies were eligible and included. There was significant variability in practice, with a variety of ultrasound techniques being used and a variety of staff members performing clinical screening. Treatment rate ranged from 16.4/1,000 to 0.8/1,000. Late presentation rate ranged from 1.28/1,000 to 0.27/1,000.
Discussion: In spite of a national consensus statement, there is no standardised approach to clinical or ultrasound screening in the UK. A variety of different methods are used, which may explain the persistently high late presentation rate. A national system of quality control and a standardised screening process is recommended, with specialised training in the Graf method of ultrasound.
Medical attention to uric acid (UA) has been increasing in recent years, mainly because this molecule has been shown to be associated with increased cardiovascular risk, both in the general population and in the hypertensive patients. A growing body of clinical and experimental data supports this view and prompts reconsideration of the role of UA in the development of atherosclerosis and the genesis of cardiovascular disease. It is known that this substance, in certain plasma concentrations, induces increased oxidative stress, a chronic inflammatory state, and a whole series of other modifications that are potentially deleterious at the cardiovascular level leading to hypertension, atherosclerosis, atrial fibrillation (AF), and other metabolic changes such as diabetes, metabolic syndrome, non-alcoholic fatty liver disease and kidney failure. Despite this epidemiologic and mechanistic evidence, the current guidelines from international cardiology scientific societies do not give precise indications in this regard, and some of them only suggest UA evaluation as part of an initial screening of the hypertensive patient. The purpose of this review is to briefly describe the main clinical and epidemiological evidence supporting the role of hyperuricemia as a possible emerging cardiovascular risk factor and to analyze the potential pathophysiological mechanisms through which elevated UA levels may exert a detrimental effect on the cardiovascular system.
Hip ultrasound, according to Graf, is a standardized sonographic method for the detection of developmental dysplasia of the hip (DDH) during the neonatal period. Graf established his method during the 1980s in his home country Austria. It was implemented in the Austrian Mother-Child Health Passport in 1992. Since then it served as a general screening method. The aim of this paper is to present the effects of general hip ultrasound screening in Austria by reviewing and analysing the literature of Austrian authors. This article described how the method was further developed and which prerequisites are currently required for a correct diagnosis. Moreover, it reports about the education in ultrasound screening according to Graf in Austria.
Background: We performed a service evaluation of local patients with rheumatoid arthritis (RA) treated with biologic or targeted systemic disease-modifying anti-rheumatic drug (b/ts)DMARDs to see if patients who were obese had different outcomes, and whether referral to specialist obesity services was considered. In addition, we undertook a systematic review of the impact of obesity on treatment outcomes in patients with RA receiving biologics.
Methods: A retrospective case note review was performed for 220 patients with RA attending clinic on treatment with a (b/ts)DMARD. BMI, DAS28, DAS components and demographics were recorded. Referrals to weight management services were evaluated. A systematic review was performed according to PRISMA guidelines (PROSPERO CRD42023433669). Electronic databases were searched for papers reporting RA patients receiving biologics with clinical responses in patients with and without obesity.
Results: Within our service, 24% of patients were obese; 12% were morbidly obese. Patients with obesity had higher disease activity scores. Only 25% of eligible patients were referred to weight management services. 238 records were identified through database searches. 69 full-text records were assessed for eligibility and data extracted from 39 records including 40,445 patients receiving a variety of biologic agents. Reduced responses, remission rates, and drug retention were seen in patients with obesity receiving TNF inhibitors (TNFi), but this was not seen for abatacept, rituximab, or tocilizumab.
Discussion: Obesity is common in patients with RA and can be associated with higher disease activity. Patients who are obese are less likely to reach remission with TNFi. The use of non-TNFi biologics should be considered earlier in the treatment pathway alongside holistic approaches to aid lifestyle change for this patient group.
A 76-year-old male patient who has been suffering from psoriatic arthritis (PsA) for 15 years was diagnosed with chronic lymphocytic leukemia (CLL) 18 months ago. He has been treated him with a Bruton’s tyrosine kinase (BTK) inhibitor (ibrutinib) at a dose of 420 mg once daily (q.d.) for his CLL. For about two years, he received a quite successful treatment with methotrexate and the subcutaneously administered tumor necrosis factor (TNF) inhibitor (adalimumab) for his PsA, until his plaque psoriasis worsened. He consulted us when the severity of his skin condition necessitated a change in his treatment regimen. In the following discussion, we explore treatment options for this clinical scenario, with a particular focus on managing PsA in the context of CLL as a comorbidity. Additionally, we report on the initial phase of treatment with an anti-interleukin-23 (IL-23) inhibitor (guselkumab), specifically targeting his aggravated psoriasis.
Aim: Numerous investigations have revealed sex differences in recovery outcomes in individuals who have sustained work-related musculoskeletal injuries (WRMIs). Previous research has also revealed significant sex differences in the prevalence and severity of post-traumatic stress symptoms (PTSS) following musculoskeletal injury. This study investigated whether PTSS mediated sex differences in recovery outcomes in individuals receiving treatment for a work-related musculoskeletal injury. The recovery outcomes of interest in the present study were pain severity and pain-related disability.
Methods: The study sample included 137 individuals (68 men; 69 women) with WRMIs who were enrolled in a 7-week physical rehabilitation program. Participants completed measures of pain severity, pain disability and PTSS at admission and termination of the physical rehabilitation program.
Results: Consistent with previous research, independent samples t-tests revealed that women obtained significantly higher baseline scores on measures of pain severity (P < 0.01), number of pain sites (P < 0.001), depression (P < 0.001) and PTSS (P < 0.001) compared to men. Also consistent with previous research, the measure of PTSS, assessed at baseline, was prospectively associated with treatment-related disability reduction (P < 0.01), and return to work (P < 0.01). Bootstrap regression analyses revealed that PTSS partially mediated the relation between sex and pain-related disability.
Conclusions: The results of the present study suggest that the experience of PTSS might be one of the factors that explain sex differences in recovery outcomes following a WRMI. The results call for greater attention to the assessment and intervention of PTSS in individuals who have sustained WRMIs.