Preliminary definitions for the sonographic features of synovitis in children

Objectives Musculoskeletal ultrasonography (US) has the potential to be an important tool in the assessment of disease activity in childhood arthritides. To assess pathology, clear definitions for synovitis need to be developed first. The aim of this study was to develop and validate these definitions through an international consensus process. Methods The decision on which US techniques to use, the components to be included in the definitions as well as the final wording were developed by 31 ultrasound experts in a consensus process. A Likert scale of 1-5 with 1 indicating complete disagreement and 5 complete agreement was used. A minimum of 80% of the experts scoring 4 or 5 was required for final approval. The definitions were then validated on 120 standardized US images of the wrist, MCP and tibiotalar joints displaying various degrees of synovitis at various ages. Results B-Mode and Doppler should be used for assessing synovitis in children. A US definition of the various components (i.e. synovial hypertrophy, effusion and Doppler signal within the synovium) was developed. The definition was validated on still images with a median of 89% (range 80-100) of participants scoring it as 4 or 5 on a Likert scale. Conclusions US definitions of synovitis and its elementary components covering the entire pediatric age range were successfully developed through a Delphi process and validated in a web-based still images exercise. These results provide the basis for the standardized US assessment of synovitis in clinical practice and research

ULTRASONOGRAPHY OF MAJOR SALIVARY GLANDS IN JUVENILE SJOGREN'S SYNDROME - PRELIMINARY FINDINGS IN A MULTI-CENTER STUDY

Haukeland Hosp, Dept Rheumatol, Bergen, NorwayUniv Fed Espirito Santo, Dept Rheumatol, Med Clin, Vitoria, BrazilUniv Fed Rio de Janeiro, Dept Rheumatol, Rio De Janeiro, BrazilUniv Sao Paulo, Hosp Clin HCFMUSP, Sjogrens Syndrome Outpatient, Sao Paulo, BrazilOslo Univ Hosp, Dept Rheumatol, Oslo, NorwayHosp Gen Univ Gregorio Maranon, Dept Rheumatol, Madrid, SpainUniv Fed Sao Paulo, Dept Pediat Rheumatol, Sao Paulo, BrazilUniv Med Ctr Groningen, Dept Rheumatol & Clin Immunol, Groningen, NetherlandsUniv Sao Paulo, Sch Med, Div Rheumatol, Sao Paulo, BrazilUniv Groningen, Univ Med Ctr Groningen, Dept Rheumatol & Clin Immunol, Groningen, NetherlandsUniv Bergen, Dept Clin Sci, Rheumatol Sect, Bergen, NorwayUniv Bergen, Dept Clin Sci, Broegelmann Res Lab, Bergen, NorwayUniv Bergen, Sect Oral & Maxillofacial Radiol, Dept Clin Dent, Bergen, NorwayUniv Fed Sao Paulo, Dept Pediat Rheumatol, Sao Paulo, BrazilWeb of Scienc

Low blood levels of LRG1 before radical prostatectomy identify patients with high risk of progression to castration-resistant prostate cancer

Background After radical prostatectomy (RP), depending on stage, up to 40% of patients with prostate cancer (PCa) will experience biochemical failure (BF). Despite salvage therapy, approximately one-third of these patients will need permanent hormone therapy (pHT) and are at risk of progression to castration-resistant PCa (CRPC). Prognostic markers herald the need for neoadjuvant, adjuvant, or multimodal treatment. Objective To evaluate the added value of blood LRG1 in predicting treatment failure in patients who have undergone radical prostatectomy (RP). Design, setting, and participants We quantified LRG1 in serum or plasma sampled before radical prostatectomy from patients from the Martini-Klinik (Martini; n = 423), the Danish CuPCa cohort (CuPCa; n = 182), and Oslo University Hospital (OUH; n = 145). Outcome measurements and statistical analysis The endpoints were BF, pHT, and CRPC. The association between LRG1 and survival outcomes was evaluated using Kaplan-Meier estimation and Cox proportional-hazards modeling. The added predictive value of LRG1 in nested models was estimated using the concordance index, time-dependent area under the receiver operating characteristic curve, and decision curve analysis. Results and limitations In multivariable Cox models using preoperative characteristics, LRG1 was associated with an estimated lower risk of BF in the Martini cohort (adjusted hazard ratio [aHR] 0.68, 95% confidence interval [CI] 0.52–0.90) and in the CuPCa cohort (aHR 0.47, 95% CI 0.30–0.73). Using preoperative prognostic variables, our data showed that doubling of LRG1 was also associated with a lower risk of pHT receipt in the CuPCa cohort (aHR 0.43, 95% CI 0.20–0.93) and of CRPC development in the OUH cohort (aHR 0.32, 95% CI 0.15–0.69). Similar aHR values were observed using either preoperative or postoperative variables for all endpoints. Conclusions PCa patients with high blood LRG1 are at lower risk of BF, pHT receipt, and progression to CRPC. Since LRG1 adds value to established prognostic models, new prognostic factor combinations including LRG1 should be considered in future studies. Patient summary We measured concentrations of the blood-based protein LRG1 before surgery for prostate cancer. Patients with high LRG1 levels had better disease-free survival, suggesting that LRG1 can help in predicting prognosis