A prospective evaluation of ultrasound as a diagnostic tool in acute microcrystalline arthritis.

The performance of ultrasound (US) in the diagnosis of acute gouty (MSU) arthritis and calcium pyrophosphate (CPP) arthritis is not yet well defined. Most studies evaluated US as the basis for diagnosing crystal arthritis in already diagnosed cases of gout and few prospective studies have been performed. One hundred nine consecutive patients who presented an acute arthritis of suspected microcrystalline arthritis were prospectively included. All underwent an US of the symptomatic joints(s) and of knees, ankles and 1(st) metatarsopalangeal (MTP) joints by a rheumatologist "blinded" to the clinical history. 92 also had standard X-rays. Crystal identification was the gold standard. Fifty-one patients had MSU, 28 CPP and 9 had both crystals by microscopic analysis. No crystals were detected in 21. One had septic arthritis. Based on US signs in the symptomatic joint, the sensitivity of US for both gout and CPP was low (60% for both). In gout, the presence of US signs in the symptomatic joint was highly predictive of the diagnosis (PPV = 92%). When US diagnosis was based on an examination of multiple joints, the sensitivity for both gout and CPP rose significantly but the specificity and the PPV decreased. In the absence of US signs in all the joints studied, CPP arthritis was unlikely (NPV = 87%) particularly in patients with no previous crisis (NPV = 94%). X-ray of the symptomatic joints was confirmed to be not useful in diagnosing gout and was equally sensitive or specific as US in CPP arthritis. Arthrocenthesis remains the key investigation for the diagnosis of microcrystalline acute arthritis. Although US can help in the diagnostic process, its diagnostic performance is only moderate. US should not be limited to the symptomatic joint. Examination of multiple joints gives a better diagnostic sensitivity but lower specificity

Rheumatology training experience across Europe : Analysis of core competences

Publisher Copyright: © 2016 The Author(s). Copyright: Copyright 2019 Elsevier B.V., All rights reserved.Background: The aim of this project was to analyze and compare the educational experience in rheumatology specialty training programs across European countries, with a focus on self-reported ability. Method: An electronic survey was designed to assess the training experience in terms of self-reported ability, existence of formal education, number of patients managed and assessments performed during rheumatology training in 21 core competences including managing specific diseases, generic competences and procedures. The target population consisted of rheumatology trainees and recently certified rheumatologists across Europe. The relationship between the country of training and the self-reported ability or training methods for each competence was analyzed through linear or logistic regression, as appropriate. Results: In total 1079 questionnaires from 41 countries were gathered. Self-reported ability was high for most competences, range 7.5-9.4 (0-10 scale) for clinical competences, 5.8-9.0 for technical procedures and 7.8-8.9 for generic competences. Competences with lower self-reported ability included managing patients with vasculitis, identifying crystals and performing an ultrasound. Between 53 and 91 % of the trainees received formal education and between 7 and 61 % of the trainees reported limited practical experience (managing ≤10 patients) in each competence. Evaluation of each competence was reported by 29-60 % of the respondents. In adjusted multivariable analysis, the country of training was associated with significant differences in self-reported ability for all individual competences. Conclusion: Even though self-reported ability is generally high, there are significant differences amongst European countries, including differences in the learning structure and assessment of competences. This suggests that educational outcomes may also differ. Efforts to promote European harmonization in rheumatology training should be encouraged and supported.publishersversionPeer reviewe

Spondyloarthropathies: traitements conventionnels et anti-TNF [Spondylarthropathies: conventional treatments and anti-TNF]

Les AINS sont le traitement de première ligne des spondyloarthropathies (SpA) car ils ont démontré leur efficacité dans leur utilisation à court et long termes, en utilisation à la demande ou continue. La prévention de la progression radiologique reste débattue. Le prescripteur doit toutefois prendre en compte les effets secondaires cardiovasculaires, gastro-intestinaux et rénaux des AINS.Les immunosuppresseurs comme le méthotrexate ou la corticothérapie systémique occupent une place marginale dans la prise en charge des SpA.En cas d’échec des traitements par AINS, un des cinq anti-TNF disponibles en Suisse peut être indiqué, tous ayant démontré leur efficacité dans les SpA. Leur prescription par le rhumatologue nécessite un bilan prétraitement et un suivi du patient au long cours. [Non-steroidal anti-inflammatory drugs (NSAID) are the first line treatment for spondylarthritis. NSAIDs are effective when used continuously or on demand, in short or long-term use. An effect on radiologic progression of the spine is still controversial. However, physicians have to be aware of potential cardiovascular, renal or gastro-intestinal secondary effects when prescribing NSAIDs. DMARDs like methotrexate or systemic corticosteroids are generally not recommended for the treatment of spondylarthritis. After NSAIDs failure, a TNF inhibitor can be used. 5 anti-TNF are available in Switzerland and they are all effective in this disease. Before starting an anti-TNF treatment, a screening is mandatory. Patients treated with an anti-TNF must be followed regularly.

Arthrite 4.0 : le cycle numérique est en marche [Arthritis 4.0 : The digital cycle has begun]

Current digital solutions in rheumatology support patients in terms of information and communication. E-diagnosis and symptom checker potentially reduce the delay of diagnosis. Patient reported outcome is increasingly used to monitor disease activity. In future, motion tracker and other types of sensors e.g. in smartphones might provide further information in order to predict disease flares. Artificial intelligence will likely be used for disease stratification, prediction and treatment choice. Together a « digital cycle » including diagnosis, surveillance and treat-ment decision is going to be established. The role of the rheuma-tologists within this cycle needs to be defined

Syndrome de Sjögren : du diagnostic au traitement [Sjögren's syndrome: from diagnosis to treatment]

Sjögren's syndrome (SS) is an auto-immune condition involving salivary and lacrymal glands leading to dry mouth and dry eyes symptoms. Some patients also present with systemic manifestations. Diagnosis of SS is made after clinical, serological, and histological assessment according to the American College of Rheumatology and European League Against Rheumatism (EULAR) classification criteria. Recent clinical trials showed a significant decrease of systemic activity of SS in patients treated with iscalimab (anti-CD40) and ianalumab (anti-BAFF-R). These results need to be confirmed in larger studies. However, two phase 3 randomized trials did not show efficacy treating SS with abatacept. We also describe in this article the first EULAR recommendations on SS management

Complications et atteintes systémiques de la polyarthrite rhumatoïde [Complications and systemic manifestations of rheumatoid arthritis].

Rheumatoid arthritis (RA), in addition to the traditional joint damage can affect all organs as a systemic disease. Extra-articular manifestations of RA are highly variable ranging from rheumatoid nodules (most common) to rheumatoid vasculitis presenting a significant morbidity and mortality (49% at 5 years). With the new algorithms of treatment (earlier) and the use of biologics, the incidence of severe extra-articular manifestations decreases. Regarding the treatment of rheumatoid vasculitis, rituximab looks promising. RA also increases cardiovascular risk and the risk of osteoporosis. It is therefore important to identify these risks and, if appropriate, treat them. Collaboration with the general practitioner is essential in this situation

Interleukin-1 as a therapeutic target in gout.

PURPOSE OF REVIEW: To give an overview of current evidence for interleukin (IL)-1 blockade in the management of gout. RECENT FINDINGS: Three IL-1 blockers are currently available for clinical use: anakinra, rilonacept and canakinumab. Recent studies have focused on drugs with a long half-life: rilonacept and canakinumab. For treatment of acute gouty arthritis, three randomized controlled trials (RCTs) showed efficacy of canakinumab with some safety concerns and one RCT failed to show efficacy of rilonacept. For prevention of gout flare when starting uric acid lowering therapy (ULT), four RCTs showed efficacy of rilonacept and one RCT showed efficacy of canakinumab. SUMMARY: There is sufficient evidence supporting the use of IL-1 blockers for treatment of acute gouty arthritis or for prevention of gout flares when starting ULT in selected patients, with contraindications or intolerance to conventional therapy. More data are needed to assess safety and to specify their use in routine practice