Morbid anatomy of 'erosive osteoarthritis' of the interphalangeal finger joints : an optimised scoring system to monitor disease progression in affected joints

Objectives To develop and validate a quantitative radiographic scoring system, the Ghent University Scoring System (GUSS), with better ability to detect progression over a shorter period of time in erosive osteoarthritis (OA) of the interphalangeal (IP) finger joints compared with the existing anatomic phase scoring system. Methods Thirty IP finger joints showing erosive features at baseline or follow-up were selected from 18 patients with erosive hand OA. Posteroanterior radiographs of these joints obtained at baseline, 6 and 12 months-totalling 90 images-were used for the study. All joints were first scored according to the original anatomic phase scoring system. Erosive progression and signs of repair or remodelling were then scored by indicating the proportion of normal subchondral bone, subchondral plate and joint space on an 11-point rating scale (range 0-100 with 10 unit increases). Inter-and intrareader reproducibility was studied using intraclass correlation coefficients (ICCs). Based on the within-variance of two readers, the smallest detectable change (SDC) was calculated and allowed identification of joints with changes above the SDC as 'progressors'. Results Longitudinal inter-reader ICC scores rated well for all variables and the total score (ICC 0.86-0.93). To identify 'real' change over background noise, a change of at least 40 units on the total score (range 0-300) over 12 months (SDC 0-12: 36.0), and 50 units over 6 months (SDC 0-6: 47.6) had to be present. 60% of the 30 joints were identified as 'progressors' over 6 months compared with 33.3% with the classical anatomical scoring system, and 70% versus 56.6%, respectively, over 12 months. Conclusion GUSS, is a reliable method to score radiographic change over time in erosive IP OA and detects more progression over a shorter period of time than the classical scoring system

Abstract Padé-approximants for the solution of a sytem of nonlinear equations

AbstractLet F: Rq → Rq and let x* be a simple root of the system of nonlinear equations F(x) = 0.We will construct several iterative methods, based on the (n, m)-APA (abstract Padé-approximant) or the (n, m)-ARA (abstract rational approximant)[4] for either F (direct one-point interpolation) or its inverse operator G (inverse one-point interpolation).The following methods are special cases: n = 1, m = 0: Newton-iteration (via direct and via inverse interpolation); inverse interpolation with n = 2, m = 0: improvement of the Newton-iteration as indicated by Ehrmann[7]; direct interpolation with n = 1, m = 1: method of tangent hyperbolas[10], under certain conditions for the ARA.Among other new methods an interesting third-order iterative procedure is constructed via inverse interpolation with n = 1, m = 1: Xi+1=Xi+ai2ai+12F′i−1F″iai2 with F′i the 1st Fréchet-derivative of F at xi, ai=−F′−1iFi the Newton-correction, F″i the 2nd Fréchet-derivative of F at xi and component-wise multiplication and division in Rq.This method is to be preferred to the method of tangent hyperbolas, which is also of third order, since it requires less numerical calculations. In general, the methods derived from the use of the (n, m)-APA or (n, m)-ARA with m ⩾ 1 are preferable when F or G have singularities in the neighborhood of x* or 0 respectively

The neural representation of mental beliefs held by two agents

Neuroimaging research has demonstrated that mentalizing about false beliefs held by other people recruits the temporo-parietal junction (TPJ). However, earlier work was limited to a single agent that held a false belief. We investigated the effect of two agents that held similar or mixed false and/or true beliefs. Participants saw animated stories with two smurfs holding true or false beliefs (Story phase). At the end of each trial, they were requested to take the perspective of the self or one of the smurfs (Question phase). We predicted that an increasing number of smurfs holding a false belief would increase activation in the TPJ when participants have to report the belief of the smurf, because the incongruent belief should have a stronger influence if it is held by two compared with one agent. This prediction was confirmed as activation in the TPJ during the Story and Question phase increased when more smurfs held a false belief. Taking the perspective of the self led to stronger activation of the TPJ in the two conditions that involved a true belief and weakest activation in the condition of two false beliefs. These data suggest that activation in TPJ depends on the perspective participants take, and that the number of agents holding a false belief influences activation in the TPJ only when taking the agent's perspective

A nationwide survey on patient's versus physician's evaluation of biological therapy in rheumatoid arthritis in relation to disease activity and route of administration : the Be-Raise study

Objectives : Biological treatment of rheumatoid arthritis (RA) is one of the cornerstones of current treatment strategies for the disease. Surprisingly little information exists on whether the route of administration affects patients' treatment satisfaction. It is equally unclear whether rheumatologists are able to accurately perceive their patients' appreciation. Thus, the Belgian Beraise survey aimed to examine whether RA patient's experience of their current biological treatment coincided with the treating physician's perception. Methods : A nationwide cross-sectional survey was conducted by 67 Belgian rheumatologists providing data obtained from 550 RA patients. Patients under stable dose of biologics for at least 6 months, were enrolled consecutively and all completed questionnaires. Separate questionnaires were completed by the treating rheumatologist which evaluated their patient's perception of the route of treatment administration. This study therefore evaluates whether a treating physician perceives the satisfaction with the route of administration to the same degree as the patient. Results : Completed questionnaires were obtained from 293 and 257 patients who obtained treatment via the intravenous (IV) or subcutaneous (SC) route of administration, respectively. 58.4% of patients were in DAS28-CRP(3) remission. Patient satisfaction with disease control was higher (44% scored >= 9) than that of the treating physician (35%), regardless of the route of administration (p<0.01). No differences were seen for the patients treated with an IV as opposed to a SC route of administration. The physician's perception of patient's satisfaction with disease control was markedly lower for IV treated patients as opposed to SC treated patients (p<0.001). Conclusions : Patients' satisfaction with biological treatment is high, but there is a considerable mismatch between patients' and rheumatologists' appreciation on the route of administration of biological therapy in RA. Physicians consistently consider IV biological therapy to be less satisfactory. Patient's appreciation is largely dependent on disease control, irrespective of the route of administration. Therefore, and encouraging shared decision making, we suggest that physicians and patients discuss the route of administration of biologicals in an open way

Tumour necrosis factor blockade for the treatment of erosive osteoarthritis of the interphalangeal finger joints: a double blind, randomised trial on structure modification

Background Adalimumab blocks the action of tumor necrosis factor-alpha and reduces disease progression in rheumatoid arthritis and psoriatic arthritis. The effects of adalimumab in controlling progression of structural damage in erosive hand osteoarthritis (HOA) were assessed. Methods Sixty patients with erosive HOA on radiology received 40 mg adalimumab or placebo subcutaneously every two weeks during a 12-month randomized double-blind trial. Response was defined as the reduction in progression of structural damage according to the categorical anatomic phase scoring system. Furthermore, subchondral bone, bone plate erosion, and joint-space narrowing were scored according to the continuous Ghent University Score System (GUSS (TM)). Results The disease appeared to be active since 40.0% and 26,7% of patients out of the placebo and adalimumab group, respectively, showed at least one new interphalangeal (IP) joint that became erosive during the 12 months follow-up. These differences were not significant and the overall results showed no effect of adalimumab. Risk factors for progression were then identified and the presence of palpable soft tissue swelling at baseline was recognized as the strongest predictor for erosive progression. In this subpopulation at risk, statistically significant less erosive evolution on the radiological image (3.7%) was seen in the adalimumab treated group compared to the placebo group (14.5%) (P = 0.009). GUSSTM scoring confirmed a less rapid rate of mean increase in the erosion scores during the first 6 months of treatment in patients in adalimumab-treated patients. Conclusion Palpable soft tissue swelling in IP joints in patients with erosive HOA is a strong predictor for erosive progression. In these joints adalimumab significantly halted the progression of joint damage compared to placebo

Crime and punishment : morality judgment in a foreign language

The current study examined whether use of a foreign language affects the manner in which people evaluate a criminal situation. We employed a range of crime scenarios, for which severity judgment scores were obtained. Crimes that were written in a foreign language were systematically evaluated as less severe compared with the same cases described in the native language. We propose that these differences may be due to attenuated emotional processing in a nonnative language. Crucially, this observed variation in severity judgment may also affect magistrates and police interrogators confronted with crime scenarios formulated in a foreign tongue. This in turn would have inevitable consequences for the penalty they will or will not exact on the suspect

Archeologische opgraving Hombeek Zemstseweg

Dit rapport werd ingediend bij het agentschap samen met een aantal afzonderlijke digitale bijlagen. Een aantal van deze bijlagen zijn niet inbegrepen in dit pdf document en zijn niet online beschikbaar. Sommige bijlagen (grondplannen, fotos, spoorbeschrijvingen, enz.) kunnen van belang zijn voor een betere lezing en interpretatie van dit rapport. Indien u deze bijlagen wenst te raadplegen kan u daarvoor contact opnemen met: [email protected]

Markers and outcome measures in chronic immune mediated artrhritis: from association studies to prediction models.

This work aims to illustrate how single biomarkers and standardized clinical measures can be used in the daily clinical practice rheumatologist’s decision making and how different markers and measures can be combined into prediction models and composite indices. The first part focuses on association studies. Three association studies of carriage of Crohn’s disease associated CARD15 polymorphisms are shown. We first investigated the association between carriage of CARD15 polymorphisms and SpA related symptoms in Crohn’s disease. Inversely, the association between gut inflammation in SpA and carriage of CARD15 polymorphisms was explored. Also, an association between carriage of CARD15 polymorphisms and anti-Saccharomyces cerevisiae antibodies in Crohn’s disease patients is demonstrated. The diagnostic properties of a test are explored into more detail in part 2, illustrated by the rheumatoid factor (RF) and anti-citrullinated protein/peptide antibodies (ACPA) determination in rheumatoid arthritis (RA). ACPA is a very specific test for RA, but the specificity of this test may differ between study populations. Combinations of ACPA, RF and HLA-shared epitope testing are explored by different (predicted) probabilities plots, based on logistic regression. They demonstrate that combined ACPA and continuous RF-testing is the most relevant combination. In part 3, different single clinical measures and composite indices to measure response to treatment in RA are evaluated. 511 RA patients treated with infliximab are investigated. After a loading regimen at week 0, 2, 6 and 14, the treating rheumatologist could decide to give a dose increase at week 22. This decision to give a dose increase can be considered as a measure of insufficient response and could be best modeled by the DAS28 at the moment of decision. The same patients were followed over 4 years and also DAS28, measured at week 14 or week 22, could best predict 4-year attrition to therapy. In the last part, different methods to construct prediction models are evaluated. Discriminant analysis and logistic regression may be less performing in real life datasets with missing values and high dimensionality. In such cases, computer intensive methods – such as support vector machines and multilayerd perceptrons - may be useful