Morphology of the toe flexor muscles in older people with toe deformities

Objective: Despite suggestions that atrophied, or weak toe flexor muscles are associated with the formation of toe deformities, there has been little evidence to support this theory. This study aimed to determine whether the size of the toe flexor muscles differed in older people with and without toe deformities. Methods: Forty-four older adults (>60 years) were recruited for the study. Each participant had their feet assessed for the presence of hallux valgus or lesser toe deformities. Intrinsic and extrinsic toe flexor muscles were imaged with an ultrasound system using a standardised protocol. Assessor blinded muscle thickness and cross-sectional area was measured using Image J software. Results: Participants with lesser toe deformities (n=20) were found to have significantly smaller quadratus plantae (p=0.003), flexor digitorum brevis (p=0.013), abductor halluces (p=0.004) and flexor halluces brevis (p=0.005) muscles than the participants without any toe deformities (n=19). Female participants with hallux valgus (n=10) were found to have significantly smaller abductor hallucis (p=0.048) and flexor halluces brevis (p=0.013) muscles than the female participants without any toe deformities (n=10; p<0.05). Conclusion: This is the first study to use ultrasound to investigate the size of the toe flexor muscles in older people with hallux valgus and lesser toe deformities compared to otherwise healthy older adults. The size of the abductor hallucis and flexor hallucis brevis muscles were decreased in participants with hallux valgus whereas the quadratus plantae, flexor digitorum brevis, abductor hallucis and flexor halluces brevis muscles were smaller in those participants with lesser toe deformities

PsA-Disk, a novel visual instrument to evaluate psoriatic arthritis in psoriatic patients: an Italian derma-rheuma multicentre study

BACKGROUND: Consensus among dermatologists and rheumatologists in the diagnosis and assessment of musculoskeletal diseases in psoriasis (PsO) patients is needed. This study assesses characteristics of musculoskeletal pain in patients with PsO for the presence of psoriatic arthritis (PsA) and evaluation of a novel 16-item visual instrument (PsA-Disk). METHODS: Data were collected from eight dermatological/rheumatological centres across Italy. Patients with PsO completed PEST (Psoriasis Epidemiology Screening Tool) and PsA-Disk questionnaires during the first visit. A rheumatological visit was performed to confirm the presence of PsA. Both validity and reliability of PsA-Disk were assessed. RESULTS: A total of 573 patients with PsO were examined at the first visit, and 120 (21%) were diagnosed with PsA. Patients with PsA compared with patients with PsO (n = 119) presented statistically significant differences for: nail involvement, PEST score \u2a7e3, higher erythrocyte sedimentation rate (ESR), Nail Psoriasis Severity Index (NAPSI)-feet, NAPSI-(hands + feet) and PsA-Disk scores (73.9\u2009\ub1\u200932.1 versus 58.1\u2009\ub1\u200939.8, p\u2009<\u20090.001). Patients with PsA with knee arthritis had higher PsA-Disk scores (98.4\u2009\ub1\u200926 versus 71.5\u2009\ub1\u200931.9, p\u2009=\u20090.006) that were also correlated with number of swollen (r\u2009=\u20090.2, p < 0.05) and tender joints (r = 0.24, p = 0.021), patient (r = 0.4, p < 0.001) and physician-pain-visual analogue scale (VAS; r = 0.33, p < 0.001), patient global assessment (PGA)-VAS (r = 0.23, p = 0.025), physician-health assessment questionnaire (HAQ; r = 0.38, p = 0.011), Disease Activity Score (DAS)-44 (r = 0.25, p = 0.023) and Disease Activity in Psoriatic Arthritis (DAPSA; r = 0.31, p = 0.005). The instrument had excellent reliability in terms of internal consistency (Cronbach's alpha = 0.90) and stability (intraclass correlation = 0.98). Moderate agreement between PsA-Disk and PEST (Cohen's kappa = 0.46) was observed, while construct validity appeared appropriate [PsA + patients: PsA-Disk score (interquartile range; IQR) =71 (50-96); PsA-patients: PsA-Disk score (IQR)=50 (20-90); p < 0.001]. CONCLUSION: PsA-Disk may be considered a valid novel instrument aiding both dermatologists and rheumatologists in the rapid detection and assessment of musculoskeletal disease characteristics

Development and First Validation of a Disease Activity Score for Gout

none51OBJECTIVE: To develop a new composite disease activity score for gout and provide its first validation. METHODS: Disease activity has been defined as the ongoing presence of urate deposits that lead to acute arthritis and joint damage. Every measure for each Outcome Measures in Rheumatology core domain was considered. A 3-step approach (factor analysis, linear discriminant analysis, and linear regression) was applied to derive the Gout Activity Score (GAS). Decision to change treatment or 6-month flare count were used as the surrogate criteria of high disease activity. Baseline and 12-month followup data of 446 patients included in the Kick-Off of the Italian Network for Gout cohort were used. Construct- and criterion-related validity were tested. External validation on an independent sample is reported. RESULTS: Factor analysis identified 5 factors: patient-reported outcomes, joint examination, flares, tophi, and serum uric acid (sUA). Discriminant function analysis resulted in a correct classification of 79%. Linear regression analysis identified a first candidate GAS including 12-month flare count, sUA, visual analog scale (VAS) of pain, VAS global activity assessment, swollen and tender joint counts, and a cumulative measure of tophi. Alternative scores were also developed. The developed GAS demonstrated a good correlation with functional disability (criterion validity) and discrimination between patient- and physician-reported measures of active disease (construct validity). The results were reproduced in the external sample. CONCLUSION: This study developed and validated a composite measure of disease activity in gout. Further testing is required to confirm its generalizability, responsiveness, and usefulness in assisting with clinical decisions.noneScirè, Carlo A; Carrara, Greta; Viroli, Cinzia; Cimmino, Marco A.; Taylor, William J.; Manara, Maria; Govoni, Marcello; Salaffi, Fausto; Punzi, Leonardo; Montecucco, Carlomaurizio; Matucci-Cerinic, Marco; Minisola, Giovanni; Ariani, Alarico; Galossi, Alessandra; Lauriti, Ciro; Fracassi, Elena; Idolazzi, Luca; Bardelli, Marco; Selvi, Enrico; Tirri, Enrico; Furini, Federica; Inverardi, Flora; Calabrò, Andrea; Porta, Francesco; Bittelli, Raffaele; Venturino, Francesco; Capsoni, Franco; Prevete, Immacolata; Sebastiani, Giandomenico; Selmi, Carlo; Fabbriciani, Gianluigi; D'Avola, Giovanni; Botticella, Giulia; Serale, Francesca; Seminara, Giulia; D'Alessandro, Giuseppe; Santo, Leonardo; Longato, Lorena; Zaccara, Eleonora; Sinigaglia, Luigi; Atteritano, Marco; Broggini, Marco; Caprioli, Marta; Favero, Marta; Sallì, Salvatore; Scarati, Marco; Parisi, Simone; Malavolta, Nazzarena; Corvaglia, Stefania; Scarpato, Salvatore; Veneto, VittorioScirè, Carlo A; Carrara, Greta; Viroli, Cinzia; Cimmino, Marco A.; Taylor, William J.; Manara, Maria; Govoni, Marcello; Salaffi, Fausto; Punzi, Leonardo; Montecucco, Carlomaurizio; Matucci Cerinic, Marco; Minisola, Giovanni; Ariani, Alarico; Galossi, Alessandra; Lauriti, Ciro; Fracassi, Elena; Idolazzi, Luca; Bardelli, Marco; Selvi, Enrico; Tirri, Enrico; Furini, Federica; Inverardi, Flora; Calabrò, Andrea; Porta, Francesco; Bittelli, Raffaele; Venturino, Francesco; Capsoni, Franco; Prevete, Immacolata; Sebastiani, Giandomenico; Selmi, Carlo; Fabbriciani, Gianluigi; D'Avola, Giovanni; Botticella, Giulia; Serale, Francesca; Seminara, Giulia; D'Alessandro, Giuseppe; Santo, Leonardo; Longato, Lorena; Zaccara, Eleonora; Sinigaglia, Luigi; Atteritano, Marco; Broggini, Marco; Caprioli, Marta; Favero, Marta; Sallì, Salvatore; Scarati, Marco; Parisi, Simone; Malavolta, Nazzarena; Corvaglia, Stefania; Scarpato, Salvatore; Veneto, Vittori