Association of Interosseous Tendon Inflammation in the Hand With Different Early Arthritides in a 10-Year Magnetic Resonance Imaging Study

Objective: Inflammation around the tendons of the hand interosseous muscles (interosseous tendon inflammation [ITI]) was recently identified on magnetic resonance imaging (MRI) in a set of patients with rheumatoid arthritis (RA) and arthralgia. We conducted a large MRI study to assess the prevalence of ITI at diagnosis of RA and of other arthritides, as well as its relationship with clinical signs. Methods: A total of 1,205 patients presenting with various types of early arthritis between 2010 and 2020 underwent contrast-enhanced hand MRI as part of the prospective Leiden Early Arthritis Cohort. MRI was evaluated with blinding for clinical data, for ITI lateral of metacarpophalangeal (MCP) joints 2–5, and for synovitis/tenosynovitis/osteitis. We assessed ITI presence at baseline per diagnosis and its relationship with clinical characteristics (ie, presence of hand arthritis, increased acute phase reactants, and local joint swelling and tenderness). Logistic regression and generalized estimating equations were used with adjustment for age and established local inflammation features (synovitis/tenosynovitis/osteitis). Results: A total of 36% of patients with early RA (n = 532) had ITI; this was similar in patients with anti–citrullinated protein antibody (ACPA)-negative RA (37%) and those with ACPA-positive RA (34%; P = 0.53). ITI occurred regularly in remitting seronegative symmetrical synovitis with pitting edema (60%) and connective tissue diseases (44%) and less frequently in undifferentiated arthritis (14%), psoriatic arthritis (14%), inflammatory osteoarthritis (8%), reactive arthritis (7%), crystal arthritis (7%), and peripheral spondylarthritis (4%). ITI occurred more often in diagnoses with frequent arthritis of the hands (P &lt; 0.001) and increased acute-phase reactants (P &lt; 0.001). Within RA, ITI occurred together with local MCP joint synovitis (odds ratio [OR] 2.4, 95% confidence interval [95% CI] 1.7–3.4), tenosynovitis (OR 2.4, 95% CI 1.8–3.3), and osteitis (OR 2.2, 95% CI 1.6–3.1) on MRI. Moreover, ITI presence was associated with local MCP joint tenderness (OR 1.6, 95% CI 1.2–2.1) and swelling (OR 1.8, 95% CI 1.3–2.6), independent of age and MRI-detected synovitis/tenosynovitis/osteitis. Conclusion:ITI occurs regularly in RA and other arthritides with preferential involvement of hand joints and increased acute-phase reactants. At the MCP joint level, ITI associates independently with joint tenderness and swelling. Hence, ITI is a newly identified inflamed tissue mainly found in arthritides with particularly extensive and symptomatic inflammation.</p

Field Dependence of the Josephson Plasma Resonance in Layered Superconductors with Alternating Junctions

The Josephson plasma resonance in layered superconductors with alternating critical current densities is investigated in a low perpendicular magnetic field. In the vortex solid phase the current densities and the squared bare plasma frequencies decrease linearly with the magnetic field. Taking into account the coupling due to charge fluctuations on the layers, we extract from recent optical data for SmLa_{1-x} Sr_x CuO_{4-delta} the Josephson penetration length lambda_{ab} approximately 1100 A parallel to the layers at T=10 K.Comment: 5 pages, 6 eps-figures, final version with minor misprints correcte

The use of xenografts to prevent inferior border defects following bilateral sagittal split osteotomies:three-dimensional skeletal analysis using cone beam computed tomography

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EMG feedback tasks reduce reflexive stiffness during force and position perturbations

Force and position perturbations are widely applied to identify muscular and reflexive contributions to posture maintenance of the arm. Both task instruction (force vs. position) and the inherently linked perturbation type (i.e., force perturbations-position task and position perturbations-force tasks) affect these contributions and their mutual balance. The goal of this study is to explore the modulation of muscular and reflexive contributions in shoulder muscles using EMG biofeedback. The EMG biofeedback provides a harmonized task instruction to facilitate the investigation of perturbation type effects irrespective of task instruction. External continuous force and position perturbations with a bandwidth of 0.5–20 Hz were applied at the hand while subjects maintained prescribed constant levels of muscular co-activation using visual feedback of an EMG biofeedback signal. Joint admittance and reflexive impedance were identified in the frequency domain, and parametric identification separated intrinsic muscular and reflexive feedback properties. In tests with EMG biofeedback, perturbation type (position and force) had no effect on joint admittance and reflexive impedance, indicating task as the dominant factor. A reduction in muscular and reflexive stiffness was observed when performing the EMG biofeedback task relative to the position task. Reflexive position feedback was effectively suppressed during the equivalent EMG biofeedback task, while velocity and acceleration feedback were both decreased by approximately 37%. This indicates that force perturbations with position tasks are a more effective paradigm to investigate complete dynamic motor control of the arm, while EMG tasks tend to reduce the reflexive contribution

Disentangling heterogeneity in contemporary undifferentiated arthritis – A large cohort study using latent class analysis

Objectives: Undifferentiated arthritis(UA) is clinically heterogeneous and differs in outcomes ranging from spontaneous resolution to RA-development. Therefore, we hypothesized that subgroups exist within UA and we aimed to identify homogeneous groups based on clinical features, and thereafter to relate these groups to the outcomes spontaneous resolution and RA-development. These outcomes can only be studied in UA-patients in which DMARD-treatment does not influence the natural disease course; these cohorts are scarce. Methods: We studied autoantibody-negative UA-patients (not fulfilling 1987/2010 RA-criteria, no alternate diagnosis), included in the Leiden Early Arthritis Clinic between 1993 and 2006, when early DMARD-treatment in UA was infrequent. Latent class analysis was used to identify subgroups based on combinations of clinical features. Within these subgroups, test-characteristics were assessed for spontaneous resolution of arthritis and RA-development within 1 year. Results: 310 consecutive UA-patients were studied. Five classes were identified: location and number of swollen joints were most distinguishing. Classes were characterized by: 1) polyarthritis, often symmetric; 2) oligoarthritis, frequently with subacute onset; 3) wrist-monoarthritis, often with subacute onset, increased BMI and without morning stiffness; 4) small-joint monoarthritis, often without increased acute phase reactants, and 5) large-joint monoarthritis, often with subacute onset. Studying the classes in relation to the outcomes revealed that patients without spontaneous resolution (thus having persistent disease) were nearly absent in the classes characterized by monoarthritis (specificity &gt;90%). Additionally, patients who developed RA were infrequent in monoarthritis classes (sensitivity &lt;7%). Conclusion: Using a data-driven unsupervised approach, five subgroups within contemporary UA were identified. These have differences in the natural course of disease.</p