Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial)

Background: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. Methods: This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0–100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. Discussion: Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. Trial registration: Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. ClinicalTrials.gov NCT04755127. Registered after the start of inclusion on 15 February 2021

Relationships between perceived parental involvement in homework, student homework behaviors, and academic achievement: differences among elementary, junior high, and high school students

This study aims to produce a deeper understanding of the relationship between perceived parental homework involvement (i.e., parental homework control and parental homework support), student homework behaviors (i.e., time spend on homework completion, time management, and amount of homework completed), and student academic achievement. Using Mplus5.1, a structural equation model was fit for 1683 students at different stages of schooling (i.e., elementary school -aEuro parts per thousand 5th and 6th grades; junior high school -aEuro parts per thousand 7th and 8th grades; and high school -aEuro parts per thousand 9th and 10th grades). The data showed that student homework behaviors, perceived parental homework involvement, and academic achievement are significantly related. However, results vary depending on the students' grade level: (a) in junior high and high school, perceived parental homework involvement is related to students' homework behaviors, but not in elementary school; and (b) although students' homework behaviors are related to academic achievement at each school level, the direction and magnitude of the relationships vary. Specifically, the relationship between perceived parental homework involvement and academic achievement is stronger in junior high and high school than in elementary school; and student homework behaviors mediate the association between perceived parental homework involvement (control and support) and academic achievement only in junior high and high school.This manuscript was completed with the help of funding from Ministry of Science and Innovation (EDU2010-16231 and PSI2011-23395) and the Ministry of Economy and Finance (BES-2011-043927) of Spain.info:eu-repo/semantics/publishedVersio