Musculoskeletal and Nerve Ultrasonography

Musculoskeletal ultrasound had gained more and more importance lately and there is no doubt now about its role in the diagnosis and management of rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, osteoarthritis and crystal related arthropathies. We can say that now, US is a widely available, non-invasive, and cost-effective technique suitable for the evaluation of the articular and periarticular structures, such as joints, tendons, muscles, ligaments, and bursa. The real-time capabilities of the US allow continuous observation of those structures during movement and of the needle placement during musculoskeletal interventions. More than this, recently, ultrasonography (US) has gained its rights in the evaluation of Sjogren syndrome and giant cell arteritis. Thus, US can detect changes secondary to both inflammatory joint diseases, like synovitis, tenosynovitis or enthesitis, and to degenerative disease, like osteophytes or tendinosis. US can identify calcium pyrophosphate and urate deposits at the level of the cartilage and tendons and to recognize the changes at the level of the salivary glands in the context of the Sjogren’s syndrome and the ones at the level of the temporal artery, secondary to giant cell arteritis

The effect of glucosamine, chondroitin and harpagophytum procumbens on femoral hyaline cartilage thickness in patients with knee osteoarthritis– An MRI versus ultrasonography study

Background: the evaluation of cartilage thickness has become possible with new techniques such as musculoskeletal ultrasonography (US) and magnetic resonance imagining (MRI), making the evaluation of the treatment response and the progression of the disease more accurate. Objective: to evaluate the efficacy of a Symptomatic Slow Acting Drug for Osteoarthritis using both US and MRI for measuring cartilage thickness at baseline and after 1 year. Methods: The study included the clinical evaluation of 20 patients at baseline, at 6 and 12 months as well as imaging exams (US and MRI) at baseline and after 1 year. Measurements were performed in both knees, in lateral and medial condyles, and in the intercondylar area. After the baseline visit, patients underwent a SYSADOA treatment which included Harpagophytum procumbens (HPc) administered on a daily basis, in a specific regimen. Results and discussions: The US examination permitted the detailed evaluation of the femoral hyaline cartilage thickness, with statistically significant differences before and after treatment at the level of the medial compartment, both in the dominant (1.59±0.49 vs. 1.68±0.49, p=0.0013) and non-dominant knee (1.73±0.53 vs. 1.79±0.52, p=0.0106). The US and the MRI correlated well (r=0.63) and showed no radiographic progression in knee osteoarthritis after one year of treatment with specific SYSADOA. Moreover, the US showed improvement in the cartilage thickness of the medial compartment. Conclusions: The combination with HPc could increase the delay in the radiographic progression of the knee osteoarthritis, with improvement of femoral hyaline cartilage thickness in the medial and lateral compartment. The US might be an important tool in OA evaluation and monitoring

Applications of artificial intelligence in musculoskeletal ultrasound: narrative review

Ultrasonography (US) has become a valuable imaging tool for the examination of the musculoskeletal system. It provides important diagnostic information and it can also be very useful in the assessment of disease activity and treatment response. US has gained widespread use in rheumatology practice because it provides real time and dynamic assessment, although it is dependent on the examiner’s experience. The implementation of artificial intelligence (AI) techniques in the process of image recognition and interpretation has the potential to overcome certain limitations related to physician-dependent assessment, such as the variability in image acquisition. Multiple studies in the field of AI have explored how integrated machine learning algorithms could automate specific tissue recognition, diagnosis of joint and muscle pathology, and even grading of synovitis which is essential for monitoring disease activity. AI-based techniques applied in musculoskeletal US imaging focus on automated segmentation, image enhancement, detection and classification. AI-based US imaging can thus improve accuracy, time efficiency and offer a framework for standardization between different examinations. This paper will offer an overview of current research in the field of AI-based ultrasonography of the musculoskeletal system with focus on the applications of machine learning techniques in the examination of joints, muscles and peripheral nerves, which could potentially improve the performance of everyday clinical practice

The effect of glucosamine, chondroitin and harpagophytum procumbens on femoral hyaline cartilage thickness in patients with knee osteoarthritis– An MRI versus ultrasonography study

Background: the evaluation of cartilage thickness has become possible with new techniques such as musculoskeletal ultrasonography (US) and magnetic resonance imagining (MRI), making the evaluation of the treatment response and the progression of the disease more accurate. Objective: to evaluate the efficacy of a Symptomatic Slow Acting Drug for Osteoarthritis using both US and MRI for measuring cartilage thickness at baseline and after 1 year. Methods: The study included the clinical evaluation of 20 patients at baseline, at 6 and 12 months as well as imaging exams (US and MRI) at baseline and after 1 year. Measurements were performed in both knees, in lateral and medial condyles, and in the intercondylar area. After the baseline visit, patients underwent a SYSADOA treatment which included Harpagophytum procumbens (HPc) administered on a daily basis, in a specific regimen. Results and discussions: The US examination permitted the detailed evaluation of the femoral hyaline cartilage thickness, with statistically significant differences before and after treatment at the level of the medial compartment, both in the dominant (1.59±0.49 vs. 1.68±0.49, p=0.0013) and non-dominant knee (1.73±0.53 vs. 1.79±0.52, p=0.0106). The US and the MRI correlated well (r=0.63) and showed no radiographic progression in knee osteoarthritis after one year of treatment with specific SYSADOA. Moreover, the US showed improvement in the cartilage thickness of the medial compartment. Conclusions: The combination with HPc could increase the delay in the radiographic progression of the knee osteoarthritis, with improvement of femoral hyaline cartilage thickness in the medial and lateral compartment. The US might be an important tool in OA evaluation and monitoring

Imaging Study of Pseudotumoral Chronic Sialadenitis with Cystic-Like Pattern in a Sjögren Syndrome Patient

Ultrasonography has become a valuable tool for the assessment of salivary gland involvement in Sjögren syndrome. Diagnostic pitfalls can be encountered in late stages of the disease, in which morphologic changes may overlap with other pathologies of the salivary glands. We present the case of a female Sjögren syndrome patient with lack of significant sicca symptoms and unilateral occurrence of parotidomegaly, which prompted the suspicion of a parotid gland tumor. Due to the atypical clinical profile, diagnosis of Sjögren syndrome was delayed, at which point, severe sialadenitis produced a cystic transformation of the parotid gland parenchyma

Influence of Random Plasmonic Metasurfaces on Fluorescence Enhancement

One of the strategies employed to increase the sensitivity of the fluorescence-based biosensors is to deposit chromophores on plasmonic metasurfaces which are periodic arrays of resonating nano-antennas that allow the control of the electromagnetic field leading to fluorescence enhancement. While artificially engineered metasurfaces realized by micro/nano-fabrication techniques lead to a precise tailoring of the excitation field and resonant cavity properties, the technological overhead, small areas, and high manufacturing cost renders them unsuitable for mass production. A method to circumvent these challenges is to use random distribution of metallic nanoparticles sustaining plasmonic resonances, which present the properties required to significantly enhance the fluorescence. We investigate metasurfaces composed of random aggregates of metal nanoparticles deposited on a silicon and glass substrates. The finite difference time domain simulations of the interaction of the incident electromagnetic wave with the structures reveals a significant enhancement of the excitation field, which is due to the resonant plasmonic modes sustained by the nanoparticles aggregates. We experimentally investigated the role of these structures in the fluorescent behaviour of Rhodamine 6G dispersed in polymethylmethacrylate finding an enhancement that is 423-fold. This suggests that nanoparticle aggregates have the potential to constitute a suitable platform for low-cost, mass-produced fluorescent biosensors

Bisphenol A Adsorption on Silica Particles Modified with Beta-Cyclodextrins

This study presents the synthesis of silica particles bearing two beta-cyclodextrin (BCD) (beta-cyclodextrin-BCD-OH and diamino butane monosubstituted beta-cyclodextrin-BCD-NH2). The successful synthesis of the BCD-modified silica was confirmed by FT-IR and TGA. Using contact angle measurements, BET analysis and SEM characterization, a possible formation mechanism for the generation of silica particles bearing BCD derivatives on their surface was highlighted. The obtained modified silica displayed the capacity to remove bisphenol A (BPA) from wastewater due to the presence of the BCD moieties on the surface of the silica. The kinetic analysis showed that the adsorption reached equilibrium after 180 min for both materials with qe values of 107 mg BPA/g for SiO2-BCD-OH and 112 mg BPA/g for SiO2-BCD-NH2. The process followed Ho’s pseudo-second-order adsorption model sustaining the presence of adsorption sites with different activities. The fitting of the Freundlich isotherm model on the experimental results was also evaluated, confirming the BCD influence on the materials’ adsorption properties

DIFFERENTIAL DIAGNOSIS BETWEEN STATIN MYOTOXICITY AND INFLAMMATORY MYOSITIS – CASE PRESENTATION

Inflammatory myopathies, include polymyositis, dermatomyositis, inclusion body myositis and necrotising myopathy, but their diagnosis requires a comprehensive differential, in order to optimise treatment and to have the best outcome. One of the most controversial diagnosis in this situation is drug related myotoxicity, since the symptoms may vary significantly, but usually include muscle weakness and myalgia accompanied by elevated creatine kinase serum levels Patient background. We report a case of a 70 year-old patient, treated with statins, with onset of symptoms since one year with tolerable myalgia, accompanied by mild muscle weakness shortly after and progressive worsening in the last couple of months. Interruption of statins was recommended based on current symptoms and elevated muscle enzymes: creatine kinase (CK) x3 fold and aspartate aminotransferase (AST) x2 fold normal range. Investigations. Autoimmunity panel including anti-nuclear and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies was negative. The needle EMG was abnormal, with diffuse fibrillation potentials in almost all investigated sites, both in the proximal and distal muscles. Complex repetitive discharges were also observed in most muscles tested. Existence of clear myogenic signs on needle EMG revealed the probable cause for the clinical presentation as being myogenic in nature. Discussion. Statin-induced myopathy (SIM) is typically self-limited showing remission in the following weeks or months after statin cessation. Although EMG studies support the presence of typical myopathy features in SIM, it cannot point-out specific changes attributed to a statin-related dysfunction. Patient outcome was favorable on hospital discharge. On a two week check-up, she reported improvement in muscle strength, range of motion and remitted myalgia. Repeated blood work showed a descending trend in both CK and AST, with values in normal range. Conclusions. The clinical case, the whole algorithm of clinical evaluation and paraclinical tests that lead to final diagnosis and the literature review, highlight the importance of an exhaustive approach. Electrophysiology tests offer important aid to the physician in the approach of patients with an underlying toxic myopathy in initial diagnosis, follow-up and biopsy yield if necessary

The Influence of Socio-Demographic Factors, Lifestyle and Psychiatric Indicators on Adherence to Treatment of Patients with Rheumatoid Arthritis: A Cross-Sectional Study

Background and Objectives: Rheumatoid arthritis (RA) is a severe autoimmune disease characterized by chronic inflammation of the joints accompanied by the progressive deformation and destruction of cartilage and joint bones. This study aims to gain insight into the outcomes related to adherence in patients with rheumatoid arthritis. Predicting the medication adherence in RA patients is a key point to improve the treatment outcome. Materials and Methods: A number of 119 Romanian patients with RA were included and divided into two groups: first group included 79 patients treated with conventional therapy and second group included 40 patients treated with biologic therapy. A CQR-9 (compliance questionnaire rheumatology with nine items) and PDSQ (psychiatric diagnostic screening questionnaire) were performed to assess correlations between medication adherence, patient sociodemographic variables, 11 psychiatric scales (major depressive disorder, posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, psychosis, agoraphobia, social phobia, drug abuse/dependence, generalized anxiety disorder, somatization disorder, hypochondriasis) and lifestyle (bulimia, alcohol intake). Results: Whilst modelling factors associated with adherence, it was found that women and patients with higher education are more adherent. From the psychiatric indicators, only major depressive disorder and post-traumatic stress disorder were found to be positively correlated with therapeutic adherence. None of the assessed lifestyle factors influenced the adherence of RA patients. Conclusion: The knowledge of factors that impact on treatment adherence can be useful for clinicians to guide patient-centred care