Fluorescence optical imaging for treatment monitoring in patients with early and active rheumatoid arthritis in a 1-year follow-up period

BACKGROUND: Fluorescence optical imaging (FOI) enables visualization of inflammation in the hands in rheumatic joint diseases with currently a lack of long-term follow-up studies. OBJECTIVE: To investigate FOI for treatment monitoring in a homogenous cohort of patients with early (disease duration  3.2) RA over a period of 12 months. METHODS: Thirty-five RA patients (24 (68.6%) females, mean age 53.3 years (SD 13.6)) were investigated clinically by DAS28, tender joint count (TJC) and swollen joint count (SJC) and by FOI in phases 1-3 and PrimaVistaMode (PVM) before therapy change and after 12 months. The FOI activity score (FOIAS) was calculated based on individual joint scores from 0 to 3 in 30 joints per patient, adding up to a sum score (0-90). RESULTS: We found a statistically significant reduction of FOIAS in phase 1 from baseline (median 5.0, IQR 24.96) to follow-up (median 1.0, IQR 4.0) in all patients (p = 0.0045), both in responders and non-responders according to EULAR response criteria by DAS28. Statistically significant reductions over 12 months were found for median DAS28(ESR) 5.61 to 3.31, TJC 7.0 to 1.0, and SJC 5.0 to 1.0 (each p <  0.001). No statistically significant correlations were detected between the FOIAS change in phase 1 and DAS28(ESR), TJC, or SJC. Correlations between the other phases and clinical outcomes were weak to moderate. CONCLUSION: Reduced early enhancement in FOI phase 1 can be observed in clinically responding and non-responding early RA patients under treatment. Regarding potential marker performance, FOI probably shows a reduction of inflammation more objectively

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Get a grip on factors related to grip strength in persons with hand osteoarthritis: Results from the Nor-Hand study

Objective To compare levels of grip strength in persons with hand osteoarthritis (OA) with normative values, and examine how hand OA severity and other biopsychosocial factors are associated with grip strength. Methods Levels of grip strength across age groups were compared with normative values from the general population in sex‐stratified analyses using two‐sample T‐tests. Associations between radiographic hand OA severity (Kellgren‐Lawrence sum score) in different joint groups and grip strength of the same hand were examined in 300 persons from the Nor‐Hand study using linear regression. Analyses were repeated using markers of pain, demographic factors, comorbidities, psychological and social factors as independent variables. We adjusted for age, sex and body mass index. Results Persons with hand OA had lower grip strength than the general population, especially in persons below 60 years. In thumb base joints, increasing radiographic severity (range 0‐8) and presence of pain were associated with lower grip strength (beta=‐0.83, 95% CI ‐1.12, ‐0.53 and beta=‐2.15, 95% CI ‐3.15, ‐1.16, respectively). Negative associations with grip strength were also found for women, low education, higher comorbidity index and higher resting heart rate. Conclusion Persons with hand OA have lower grip strength than the general population. Our results support that studies on thumb base OA should include grip strength as an outcome measure. However, other biopsychosocial factors should also be considered when the grip strength is being interpreted, as other factors such as sex, socioeconomic factors, physical fitness, and comorbidities are negatively associated with grip strength

Evaluering av webleksjonene “Klinisk undersøkelse av bevegelsesapparatet” : http://www.med.uio.no/studentweb/bevegelsesapparat

In the period October-04 to January-05 a questionnaire was conducted amongst students enrolled into the 4B-semester. The main goal of this project was to evaluate how the web-based lectures was functioning as a common database for the teaching goals on the 4B-semester, independently of the student’s traineeship The answer percentages of 78 and 81 on questionnaire 1 and 2 indicates that the current curriculum were representative for the 4B-semester. Both the questionnaire from the students and the web-registered usage indicates a vast usage of the webbased lectures amongst the focal group. Based on this result it is the authors’ opinion that there exists a solid evaluation base to support the main focus of this report. The students had high expectations to the web-based lectures in the beginning of the semester. It was generally a positive feedback regarding the internet pages, and the students were reporting that they were coherent with both lectures in small groups, lectures in anatomical examination (Fu) and the lecture goals. The cooperation between the lectures in Fu and clinical small groups has on the other hand a potential for considerable improvement as they have a common lecture goal, but are not corresponding. According to the strategy implemented regarding the usage by the IKT at The Medical Faculty, it is required that the E-learning resources must be reevaluated yearly in order to avoid potential outdates. To assure the quality of the web-lectures it has been delegated to the University in Oslo lead by Lars Engebretsen. In the summer -05 the internet pages will be redesigned in order to include jointdiseases and trauma in the muscle and skeletal system which may lead to an increased use amongst other focal groups

Ultrasound-detected osteophytes predict the development of radiographic and clinical features of hand osteoarthritis in the same finger joints 5 years later

Background Structural pathology may be present in joints without radiographic evidence of osteoarthritis (OA). Ultrasound is a sensitive tool for early detection of osteophytes. Our aim was to explore whether ultrasounddetected osteophytes (in radiographically and clinically normal finger joints) predicted the development of radiographic and clinical hand OA 5 years later. Methods We included finger joints without radiographic OA (Kellgren-Lawrence grade (KLG)=0; n=301) or no clinical bony enlargements (n=717) at baseline and examined whether ultrasound-detected osteophytes predicted incident radiographic OA (KLG ≥1, osteophytes or joint space narrowing (JSN)) or incident clinical bony enlargement (dependent variables) in the same joints 5 years later. We applied logistic regression with generalised estimating equations adjusted for age, sex, body mass index and follow-up time. Results Ultrasound demonstrated osteophytes in 86/301 (28.6%) joints without radiographic OA and 392/717 (54.7%) joints without clinical bony enlargement. These osteophytes were confirmed in the majority of joints where MRI assessment was available. Significant associations were found between ultrasound-detected osteophytes and development of both radiographic OA (OR=4.1, 95% CI 2.0 to 8.1) and clinical bony enlargement (OR=3.5, 95% CI 2.4 to 5.1) and also incident radiographic osteophytes (OR=4.2, 95% CI 2.1 to 8.5) and JSN (OR=5.3, 95% CI 2.1 to 13.4). Conclusion Ultrasound-detected osteophytes predicted incident radiographic and clinical hand OA 5 years later. These results support the use of ultrasound for early detection of OA

Frequency of temporomandibular joint osteoarthritis and related symptoms in a hand osteoarthritis cohort

Objective: The prevalence of osteoarthritis (OA) in the temporomandibular joints (TMJs) in hand OA patients is largely unknown. Our aims were to explore (1) The frequency of TMJ-related symptoms and clinical findings; (2) The TMJ OA frequency defined by cone beam computed tomography (CBCT); and (3) The relationship between TMJ-related symptoms/clinical findings and CBCT-defined TMJ OA, in a hand OA cohort. Methods: We calculated the frequencies of TMJ-related symptoms, clinical findings and diagnosis of TMJ OA by CBCT and clinical examination in 54 patients from the Oslo hand OA cohort (88% women, mean (range) age 71 (61–83) years). Participants with and without CBCT-defined TMJ OA were compared for differences in proportions (95% confidence interval (CI)) of symptoms and clinical findings. Sensitivity and specificity of the clinical TMJ OA diagnosis were calculated using CBCT as reference. Results: Self-reported symptoms and clinical findings were found in 24 (44%) and 50 (93%) individuals (93%), respectively, whereas 7 (13%) had sought healthcare. Individuals with CBCT-defined TMJ OA (n = 36, 67%) reported statistically significantly more pain at mouth opening (22%, 95% CI 4–40%), clicking (33%, 95% CI 14–52%) and crepitus (25%, 95% CI 4–46%). By clinical examination, only crepitus was more common in TMJ OA (33%, 95% CI 29–77%). Clinical diagnosis demonstrated low sensitivity (0.42) and high specificity (0.93). Conclusions: CBCT-defined TMJ OA was common in hand OA patients, suggesting that TMJ OA may be part of generalized OA. Few had sought healthcare, despite high burden of TMJ-related symptoms/findings. Clinical examination underestimated TMJ OA frequency

Associations Between Radiographic and Ultrasound‐Detected Features in Hand Osteoarthritis and Local Pressure Pain Thresholds

Objective Pain sensitization contributes to the complex osteoarthritis (OA) pain experience. The relationship between imaging features of hand OA and clinically assessed pain sensitization is largely unexplored. This study was undertaken to examine the association of structural and inflammatory features of hand OA with local pressure pain thresholds (PPTs) in the Nor‐Hand study. Methods The cross‐sectional relationship of severity of structural radiographic features of hand OA (measured according to the Kellgren/Lawrence scale [grade 0–4] and the absence or presence of erosive joint disease) as well as ultrasound‐detected hand joint inflammation (assessed by gray‐scale synovitis [grade 0–3] and the absence or presence of power Doppler activity) to the PPTs of 2 finger joints was examined by multilevel regression analyses adjusted for age, sex, and body mass index, using beta values with 95% confidence intervals (95% CIs). Results A total of 570 joints in 285 participants included in the Nor‐Hand study were assessed. Greater structural and inflammatory severity was associated with lower PPTs, with adjusted beta values of −0.5 (95% CI −0.6, −0.4) per Kellgren/Lawrence grade increase, −1.4 (95% CI −1.8, −0.9) for erosive versus non‐erosive joints, −0.7 (95% CI −0.9, −0.6) per gray‐scale synovitis grade increase, and −1.5 (95% CI −1.8, −1.1) for joints with power Doppler activity on ultrasound versus those without. Conclusion Greater severity of structural pathologic features and hand joint inflammation was associated with lower PPTs in the finger joints of patients with hand OA, indicating pain sensitization. Our results indicate that pain sensitization might be driven by structural and inflammatory pathology in hand OA

The association between erosive hand osteoarthritis and subchondral bone attrition of the knee: The Framingham Osteoarthritis study

Objective To examine whether erosive hand osteoarthritis (OA) is associated with knee subchondral bone attrition (SBA) and systemic bone mineral density (BMD). Methods Associations of MRI-defined knee SBA with radiographic erosive hand OA were evaluated in 1253 Framingham participants using logistic regression with generalised estimating equations. We also examined the association between the number of erosive OA finger joints and SBA adjusted for the number of non-erosive OA finger joints. Associations between erosive hand OA and femoral neck BMD were explored in 2236 participants with linear regression. Analyses were adjusted for age, sex and body mass index. Results Participants with erosive hand OA had increased odds of knee SBA (OR = 1.60, 95% CI 1.07 to 2.38). The relation between the number of erosive OA finger joints and SBA became non-significant when adjusted for the number of non-erosive OA joints as a proxy for the burden of disease. There was a non-significant trend towards higher BMD in erosive hand OA compared with participants without hand OA. Conclusions Erosive hand OA was associated with knee SBA, but the relation might be best explained by a heightened burden of disease. No significant relation of erosive hand OA with BMD was found

Long term type 1 diabetes is associated with hand pain, disability and stiffness but not with structural hand osteoarthritis features - The Dialong hand study

Objective: To explore whether having long-term type 1 diabetes (>45 years) is associated with a higher prevalence of radiographic hand OA, erosive hand OA and increased hand pain, disability and stiffness. Methods: In total N = 96 persons with type 1 diabetes diagnosed before 1970 were included (mean [SD] age: 62.2 [7.4], mean [SD] HbA1c: 7.43 [0.80] and N = 49 [51%] men). Regular measurements of their HbA1c were obtained till 2015. We included N = 69 healthy controls without any diabetes (mean [SD] age: 63.0 [7.0], mean [SD] HbA1c: 5.41 [0.32], N = 29 [42%] men). The groups were compared for radiographic hand OA (Kellgren-Lawrence grade ≥2 in ≥1 joint) and erosive hand OA (central erosions in ≥1 joint), Australian/Canadian index (AUSCAN) for hand pain, disability and stiffness using regression analyses adjusted for age, sex, educational level and waist circumference. Results: We found no associations between having long term type 1 diabetes and more prevalent radiographic hand OA (OR = 0.83, 95% CI = 0.38-1.81). We found a trend towards higher prevalence of erosive hand OA in diabetes patients (OR = 2.96, 95% CI = 0.82-10.64). Strong and consistent associations were observed between long term type 1 diabetes and increased hand pain (B = 2.78, 95% CI = 1.65-3.91), disability (B = 5.30, 95% CI = 3.48-7.12) and stiffness (B = 2.00, 95% CI = 1.33-2.67). These associations were particularly strong for women and participants below the median age of 61 years. Conclusion: Long-term type 1 diabetes was not associated with radiographic hand OA, but was strongly associated with hand pain, disability and stiffness. The association between diabetes and erosive hand OA warrants further investigation