A comparative study between ultrasound guided and landmarks guided intraarticular sacroiliac injections in spondyloarthritis patients

Purpose: Sacroiliac joints (SIJ) inflammation and pain is particularly common in patients with Spondyloarthritis. Intraarticular SIJs injections represent a valuable therapeutic option in this condition. In the rheumatological outpatient clinics this procedure is usually done by landmark guidance (LG) or ultrasound guidance (USG). Thus we aimed to compare the short term efficacy of USG vs. LG SIJ injections using five outcome measures: 1. Pain; 2. SIJ status (number of positive provocation tests per symptomatic SIJ on physical examination); 3. Disability; 4. Quality of the night sleep; 5. Patients’ satisfaction. Methods: We enrolled 44 consecutive spondyloarthritis patients with pain in the SIJs that did not respond to NSAIDS and that were otherwise on a stable medical treatment. All patients also had ≥ 3 positive pain provocation tests per SIJ on physical examination. Patients were randomly allocated to receive a single SIJ injection with 7 mg Betamethasone (1 ml) and 1% Lidocaine (1.5 ml) either under USG or with LG. Results: Both groups showed significant improvement in all outcome parameters. However, the USG approach performed significantly better than the LG ones in all parameters. In addition, there was a significant correlation between the improvement in all patient reported outcomes (VAS, RMDQ, JSEQ) and the reduction in the number of positive SIJ pain provocation tests per symptomatic joint. Conclusion: Both USG and LG SIJ injections proved to be an efficient treatment for SIJ pain in SpA patients. However, USG of the intervention led to statistically better results in the present study

Musculoskeletal Ultrasound in Rheumatology - New Horizons

Musculoskeletal ultrasound is a non-ionizing, cheap, reproducible, reliable imaging method, well accepted by the patients, that plays an important role in daily rheumatology practice. It can be used to assess joint and periarticular involvement, including tendon, bursae, enthesis, skin thickness, nails, lung and large vessels. Musculoskeletal ultrasound is more sensitive than physical examination, improves the diagnostic process, monitoring of treatment response, the accuracy of joint and soft tissue injections. It has proved its role as an important imaging modality in a number of rheumatic diseases – inflammatory joint diseases, systemic connective tissue diseases, large-vessel vasculitides, and degenerative and metabolic bone diseases

The sonoanatomy of lumbar erector spinae and its iliac attachment – the potential substrate of the iliac crest pain syndrome, an ultrasound study in healthy subjects

Background: Iliac crest pain syndrome is a regional pain syndrome that has been identified in many patients with low back pain. Based on anatomical studies, it was suggested that the potential substrate of this syndrome might be the enthesis of the erector spinae muscle at the posterior medial iliac crest. As there have been no imaging studies of this important enthesis, our aim was to assess its characteristics by ultrasound. Methods: Erector spinae enthesis was first studied in a cadaver. Then its characteristics were recorded in 25 healthy volunteers (median age: 28.92, SD: 5.31, mean Body Mass Index 22.61, SD: 3.38), with Esaote My Lab 7 machine using linear transducer (4–13 MHz). Results: The cadaver study confirmed the attachment of a substantial part of erector spinae to a well-defined region on the medial posterior iliac crest. The US study in the volunteers consistently showed the entheses as typical hyperechoic fibrillar structures, slightly oblique to the skin in the longitudinal plane and attaching to the iliac crest. In the transverse plane, the entheses were seen as oval, densely dotted structures in contact with the superior edge of posterior superior iliac spine. Their mean thickness (4.9 ± 0.6 and 5.2 ± 0.7 mm longitudinally; 4.3 ± 0.6 and 4.4 ± 0.7 mm transversely), maximum width (16.3 ± 2.8 and 15.7 ± 2.3 mm) and depth (10.8 ± 7.3 and 10.6 ± 6.2 mm) on the left and right side, respectively, as well as their echostructure were recorded and described. Conclusions: The erector spinae entheses could be assessed in detail by ultrasound, thus their pathological transformation associated with iliac crest pain syndrome could be identified

Anatomia ultrasonograficzna lędźwiowej części mięśnia prostownika grzbietu oraz jego przyczepu biodrowego. Możliwe podłoże zespołu bólowego grzebienia biodrowego – badanie ultrasonograficzne u zdrowych osób

Background: Iliac crest pain syndrome is a regional pain syndrome that has been identified in many patients with low back pain. Based on anatomical studies, it was suggested that the potential substrate of this syndrome might be the enthesis of the erector spinae muscle at the posterior medial iliac crest. As there have been no imaging studies of this important enthesis, our aim was to assess its characteristics by ultrasound. Methods: Erector spinae enthesis was first studied in a cadaver. Then its characteristics were recorded in 25 healthy volunteers (median age: 28.92, SD: 5.31, mean Body Mass Index 22.61, SD: 3.38), with Esaote My Lab 7 machine using linear transducer (4–13 MHz). Results: The cadaver study confirmed the attachment of a substantial part of erector spinae to a well-defined region on the medial posterior iliac crest. The US study in the volunteers consistently showed the entheses as typical hyperechoic fibrillar structures, slightly oblique to the skin in the longitudinal plane and attaching to the iliac crest. In the transverse plane, the entheses were seen as oval, densely dotted structures in contact with the superior edge of posterior superior iliac spine. Their mean thickness (4.9 ± 0.6 and 5.2 ± 0.7 mm longitudinally; 4.3 ± 0.6 and 4.4 ± 0.7 mm transversely), maximum width (16.3 ± 2.8 and 15.7 ± 2.3 mm) and depth (10.8 ± 7.3 and 10.6 ± 6.2 mm) on the left and right side, respectively, as well as their echostructure were recorded and described. Conclusions: The erector spinae entheses could be assessed in detail by ultrasound, thus their pathological transformation associated with iliac crest pain syndrome could be identified.Wprowadzenie: Zespół bólowy grzebienia biodrowego jest często rozpoznawany u pacjentów z bólem okolicy lędźwiowo-krzyżowej. Na podstawie badań anatomicznych wysunięto hipotezę, że podłożem tego zespołu może być przyczep mięśnia prostownika grzbietu do tylno-środkowej części grzebienia biodrowego. Ponieważ dotychczas nie przeprowadzono badań obrazowych tej ważnej entezy, naszym celem była ocena jej charakterystycznych cech w badaniu ultrasonograficznym. Metoda: Przyczep mięśnia prostownika grzbietu zbadano najpierw na zwłokach. Następnie uzyskano jego obrazy ultrasonograficzne u 25 zdrowych ochotników (mediana wieku: 28,92, OS: 5,31; średnie BMI: 22,61, OS: 3,38) za pomocą aparatu Esaote MyLab 7, przy użyciu głowicy liniowej (4–13 MHz). Wyniki: Badanie na zwłokach potwierdziło lokalizację przyczepu istotnej części mięśnia prostownika grzbietu do wyraźnie określonego obszaru znajdującego się na tylno-środkowej części grzebienia kości biodrowej. Badania ultrasonograficzne wykonane u zdrowych osób każdorazowo uwidoczniały przyczepy jako typowe hiperechogeniczne włókniste struktury, położone nieco skośnie w stosunku do skóry w przekroju podłużnym, łączące się z grzebieniem kości biodrowej. W przekroju poprzecznym przyczepy były widoczne jako owalne, drobnopunktowe struktury stykające się z górną krawędzią kolca biodrowego tylnego górnego. Odnotowywano, odpowiednio po stronie lewej i prawej, ich średnią grubość (4,9 ± 0,6 oraz 5,2 ± 0,7 mm w przekroju podłużnym; 4,3 ± 0,6 oraz 4,4 ± 0,7 mm w przekroju poprzecznym), maksymalną szerokość (16,3 ± 2,8 oraz 15,7 ± 2,3 mm) oraz głębokość (10,8 ± 7,3 oraz 10,6 ± 6,2 mm), jak również opisywano ich echostrukturę. Wnioski: Szczegółowa ocena ultrasonograficzna przyczepów mięśnia prostownika grzbietu może pozwolić na rozpoznawanie patologii tej struktury będących przyczyną zespołu bólowego grzebienia biodrowego. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-18-no-7

Recent Insights into the Role of DNA Methylation and Histone Modifications in Systemic Sclerosis: A Scoping Review

Systemic sclerosis is a complex idiopathic disease originating from an intricate interplay between genetic susceptibility, environmental factors, and epigenetic modifications. This scoping review aims to map the advancements made regarding DNA methylation abnormalities and histone modifications in systemic sclerosis in the past decade. A literature search was conducted using three electronic databases (Scopus, Web of Science and PubMed) to identify relevant articles. A total of 44 studies were selected for this review, demonstrating the critical contribution of epigenetic perturbations in multiple cell types to disease pathogenesis. In conclusion, this scoping review has elucidated the significant discoveries made in the past decade regarding the role of DNA methylation and histone modifications in systemic sclerosis. Further progress in the field could lead to the development of novel treatment possibilities targeting epigenetic marks

Correlation between Bone Mineral Density and Progression of Hip Osteoarthritis in Adult Men and Women in Bulgaria—Results from a 7-Year Study

Changes in clinical presentation, radiographic progression (RP), bone mineral density (BMD), bone turnover (BT), and cartilage turnover (CT) markers were compared in two groups of patients with hip osteoarthritis (HOA) over a period of 7 years. Each group consisted of 150 patients, including a control group on standard-of-care therapy (SC) with simple analgesics and physical exercises, and a study group (SG) on standard-of-care therapy supplemented by vitamin D3 and intravenous administration of zoledronic acid (5 mg) yearly for 3 consecutive years. Patient groups were homogenized regarding the following: (1) radiographic grade (RG), including 75 patients with hip OA RG II according to the Kellgren–Lawrence grading system (K/L), and 75 with RG III on K/L; (2) radiographic model (RM), as each of the K/L grades was subdivided into three subgroups consisting of 25 patients of different RMs: atrophic (‘A’), intermediate (‘I’), and hypertrophic (‘H’); (3) gender-equal ratio of men and women in each subgroup (Female/Male = 15/10). The following parameters were assessed: (1) clinical parameters (CP), pain at walking (WP-VAS 100 mm), functional ability (WOMAC-C), and time to total hip replacement (tTHR); (2) radiographic indicators(RI)—joint space width (JSW) and speed of joint space narrowing (JSN), changes in BMD (DXA), including proximal femur (PF-BMD), lumbar spine (LS-BMD), and total body (TB-BMD); (3) laboratory parameters (LP)—vitamin D3 levels and levels of BT/CT markers. RV were assessed every 12 months, whereas CV/LV were assessed every 6 months. Results: Cross-sectional analysis (CsA) at baseline showed statistically significant differences (SSD) at p p < 0.05) between CG and SG in all CP (WP, WOMAC-C, tTHR) parameters of RP (mJSW, JSN), BMD of all sites, and levels of CT/BT markers for all ‘A’ models and in 30% of ‘I’-RMs (those with elevated markers for BT/CT at baseline and during the observation period). Conclusion: The presence of SSD at baseline (‘A’ vs. ‘H’) supported the thesis that at least two different subgroups of HOA exist: one associated with ‘A’ and the other with ‘H’ models. D3 supplementation and the intravenous administration of bisphosphonate were the treatment strategies that slowed down RP and postponed tTHR by over 12 months in the ‘A’ and ‘I’ RM with elevated BT/CT markers

Correlation between Bone Mineral Density and Progression of Hip Osteoarthritis in Adult Men and Women in Bulgaria&mdash;Results from a 7-Year Study

Changes in clinical presentation, radiographic progression (RP), bone mineral density (BMD), bone turnover (BT), and cartilage turnover (CT) markers were compared in two groups of patients with hip osteoarthritis (HOA) over a period of 7 years. Each group consisted of 150 patients, including a control group on standard-of-care therapy (SC) with simple analgesics and physical exercises, and a study group (SG) on standard-of-care therapy supplemented by vitamin D3 and intravenous administration of zoledronic acid (5 mg) yearly for 3 consecutive years. Patient groups were homogenized regarding the following: (1) radiographic grade (RG), including 75 patients with hip OA RG II according to the Kellgren&ndash;Lawrence grading system (K/L), and 75 with RG III on K/L; (2) radiographic model (RM), as each of the K/L grades was subdivided into three subgroups consisting of 25 patients of different RMs: atrophic (&lsquo;A&rsquo;), intermediate (&lsquo;I&rsquo;), and hypertrophic (&lsquo;H&rsquo;); (3) gender-equal ratio of men and women in each subgroup (Female/Male = 15/10). The following parameters were assessed: (1) clinical parameters (CP), pain at walking (WP-VAS 100 mm), functional ability (WOMAC-C), and time to total hip replacement (tTHR); (2) radiographic indicators(RI)&mdash;joint space width (JSW) and speed of joint space narrowing (JSN), changes in BMD (DXA), including proximal femur (PF-BMD), lumbar spine (LS-BMD), and total body (TB-BMD); (3) laboratory parameters (LP)&mdash;vitamin D3 levels and levels of BT/CT markers. RV were assessed every 12 months, whereas CV/LV were assessed every 6 months. Results: Cross-sectional analysis (CsA) at baseline showed statistically significant differences (SSD) at p &lt; 0.05 in CP (WP, WOMAC-C); BMD of all sites and levels of CT/BT markers between the &lsquo;A&rsquo; and &lsquo;H&rsquo; RM groups in all patients. Longitudinal analysis (LtA) showed SSD (p &lt; 0.05) between CG and SG in all CP (WP, WOMAC-C, tTHR) parameters of RP (mJSW, JSN), BMD of all sites, and levels of CT/BT markers for all &lsquo;A&rsquo; models and in 30% of &lsquo;I&rsquo;-RMs (those with elevated markers for BT/CT at baseline and during the observation period). Conclusion: The presence of SSD at baseline (&lsquo;A&rsquo; vs. &lsquo;H&rsquo;) supported the thesis that at least two different subgroups of HOA exist: one associated with &lsquo;A&rsquo; and the other with &lsquo;H&rsquo; models. D3 supplementation and the intravenous administration of bisphosphonate were the treatment strategies that slowed down RP and postponed tTHR by over 12 months in the &lsquo;A&rsquo; and &lsquo;I&rsquo; RM with elevated BT/CT markers

The lncRNAs/miR-30e/CHI3L1 Axis Is Dysregulated in Systemic Sclerosis

Systemic sclerosis (SSc) is an autoimmune disease with completely undefined etiology and treatment difficulties. The expression of both protein coding and non-coding RNAs is dysregulated during disease development. We aimed to examine a possible regulatory axis implemented in the control of chitinase-3 like protein 1 (CHI3L1) or YKL-40, an inflammation-associated glycoprotein, shown to be elevated in SSc. A panel of seven miRNAs and three lncRNAs potentially involved in the control of CHI3L1 were selected on the basis of in silico analysis. TagMan assay was used to evaluate the expression levels of miRNAs and RT-qPCR for lncRNAs in white blood cells (WBCs) and plasma from SSc patients and healthy controls. Among the eight screened miRNAs, miR-30e-5p (p = 0.04) and miR-30a-5p (p = 0.01) were significantly downregulated in WBCs and plasma of SSc patients, respectively. On the contrary, the expression of the metastasis associated lung adenocarcinoma transcript 1 (MALAT1) (p = 0.044) and the Nuclear enriched abundant transcript 1 (NEAT1) (p = 0.008) in WBCs was upregulated compared to the controls. Increased levels of MALAT1 and NEAT1 could be associated with the downregulation of miR-30e-5p and miR-30a-5p expression in WBCs and plasma. We present novel data on the involvement of a possible regulatory axis lncRNAs/miR-30e/CHI3L1 in SSc and hypothesize that MALAT1 and NEAT1 could act as miR-30e-5p and miR-30a-5p decoys. This may be a reason for the increased serum levels of CHI3L1 in SSc patients

YKL-40 and cytokines - a New Diagnostic Constellation in Rheumatoid Arthritis?

Background: Rheumatoid arthritis (RA) causes chronic inflammation and alteration of articular tissue and joints. The pathogenesis of the disease remains unclear although it is known that proinflammatory cytokines play a major role in its induction