Sonographic monitoring of gout

Objective: To assess the role of grayscale and power Doppler sonography in short-term monitoring of acute gouty synovitis. Methods: Clinical and sonographic assessments were performed in a patient with gout. Clinical and sonographic evaluations were performed within the first day of the acute onset of synovitis of the first metatarsophalangeal joint of the left foot and 7 and 14 days after the baseline assessments. The patient was treated only with colchicine. Results: At baseline, both grayscale and power Doppler sonography revealed clearly evident findings of acute synovitis (joint cavity widening, thickening of periarticular soft tissues and power Doppler signal). After seven days, a complete clinical remission occurred. Ultrasound examination revealed marked improvement with respect to the basic findings, even if all the sonographic features of joint inflammation were still detectable. Two weeks after the onset of the acute attack, clinical remission was maintained and all the sonographic features of synovitis disappeared. Conclusion: Sonography is a sensitive and reliable tool for assessing and short-term monitoring of acute gouty attack

The current role of ultrasound in the assessment of crystal-related arthropathies

0Over last few years, the ultrasonography (US) generated an increasing popularity among rheumatologists due to excellent potentiality and numerous applications in rheumatology. Most of the published papers focus mainly to demonstrate the utility of US in early and chronic arthritis, short-term therapy monitoring and guidance for invasive procedures. Less attention has been paid to the potential of this technique in the field of crystal-related arthropathies. By virtue of the high resolution of "new generation" equipments, minimal crystal deposits can be detected even sometime when the radiography was negative. The aim of this paper was to present the principal findings in patients with crystal-related arthropathies

Evolutive pattern of Calomys hummelincki (Husson, 1960; Rodentia, Sigmodontinae) inferred from cytogenetic and allozymic data.

The main purpose of this research was to understand the evolutive history of the sigmodontine rodent Calomys hummelincki (Husson 1960), tribe Phyllotini from chromosomal and allozymic data, and evaluate the hypotheses that explains the colonization and evolution of sigmodontine rodents in South America. C. hummelincki is restricted to the Northern South American region, which comprises Venezuela, Aruba and Curaçao islands where specimen sampling was done. The cytogenetic analysis showed that all populations studied have the same diploid number (2n=60) and fundamental number (FN=64). Constitutive heterochromatin was observed on pericentromeric positions in almost all chromosomes. NOR regions were observed on four pairs of acrocentric chromosomes. G-banding allowed us to identify almost all pair positions in the C. hummelincki chromosome complement. The G-banding also permitted a comparison of the C. hummelincki pattern with those published for C. callidus, C. venustus and C. laucha species. G-banded information indicates that hummelincki is not directly derived from laucha. The results are constrained with published allozymic and molecular data obtained in previous studies. The overall analysis seems to support Reig´s hypothesis of a south to north colonization of genus Calomys in South America

Intrinsic Qp at Mt. Etna from the inversion of rise times of 2002 microearthquake sequence

About three-hundred microearthquakes, preceeding and accompanying the 2002-2003 Mt. Etna flank eruption, were considered in this study. On the high-quality velocity seismograms, measurements of the first half cycle of the wave, the so-called rise time τ, were carried out. By using the rise time method, these data were inverted to infer an estimate of the intrinsic quality factor Qp of P waves and of the source rise time τ0 of the events, which represents an estimate of the duration of the rupture process. Two kind of inversions were carried out. In the first inversion τ0 was derived from the magnitude duration of the events, assuming a constant stress drop and Qp was inferred from the inversion of reduced rise times τ−τ0. In the second inversion both τ0 and Qp were inferred from the inversion of rise times. To determine the model parameters that realize the compromise between model simplicity and quality of the fit, the corrected Akaike information criterion was used. After this analysis we obtained Qp=57±42. The correlation among the inferred τ0 and Qp, which is caused by some events which concomitantly have high τ0 (>30 ms) and high Qp (>100) indicates that the technique used is able to model rise time versus travel time trend only for source dimensions less than about 80 m

Ultrasound in the study and monitoring of osteoarthritis

This review addresses the use of ultrasound (US) as an imaging technique for the evaluation and monitoring of the osteoarthritic joint. US complements both the clinical examination and radiological imaging by allowing the rheumatologist to recognize not only the bony profile but also to visualize the soft tissues. Systematic US scanning following established guidelines can demonstrate even minimal abnormalities of articular cartilage, bony cortex and synovial tissue. US is also extremely sensitive in the detection of soft tissue changes in the involved joints including the proliferation of the synovium and changes in the amount of fluid present within the joint. Monitoring the amount of fluid in the hip and knee joint with osteoarthritis may be a potentially useful finding in the selection of patients for clinical investigation and for assessing their response to therapeutic interventions. © 2008

Inter-observer agreement of standard joint counts in early rheumatoid arthritis: a comparison with grey scale ultrasonography—a preliminary study

Objectives. The aims of the present study were to assess the inter-observer agreement of standard joint count and to compare clinical examination with grey scale ultrasonography (US) findings in patients with early rheumatoid arthritis (RA). Methods. The study was conducted on 44 RA patients with a disease duration of <2yrs. Clinical evaluation was performed independently by two rheumatologists for detection of tenderness in 44 joints and swelling in 42 joints. All patients underwent US assessment by a rheumatologist experienced in this method and blinded to the clinical findings. Joint inflammation was detected by US when synovial fluid and/or synovial hypertrophy was identified using OMERACT preliminary definitions. The inter-observer reliability was calculated by overall agreement (percentage of observed exact agreement) and kappa (� )-statistics. The reliability of US was calculated in 12 RA patients. Results. There was fair to moderate inter-observer agreement on individual joint counts for either tenderness or joint swelling apart from the glenohumeral joint. US detected a higher number of inflamed joints than did clinical examination. The mean (� S.D.) US joint count for joint inflammation was 19.1 (� 4.1), while the mean (� S.D.) number of swollen joints was 12.6 (� 3.6), with a significant difference of P ¼0.01. Conclusions. Our results provide evidence in favour of the hypothesis that clinical examination is far from optimal for asessing joint inflammation in patients with early RA. Furthermore, this study suggests that US can considerably improve the detection of signs of joint inflammation both in terms of sensitivity and reliability

Thumb troubles in rheumatoid arthritis

Thumb involvement may play a relevant role in inducing a severe functional impairment in rheumatoid arthritis. The aim of this sonographic vignette is to show the value of sonography in detailing anatomic changes involving the thumb during a phase of active synovitis. The patient was a 50-year old man who presented with a 3-year history of rheumatoid arthritis. He complained of a 4-week history of a marked recrudescence inflammatory thumb involvement associated with clinical signs of carpal tunnel syndrome. Sonographic images were obtained with a real-time ultrasound system equipped with a 13 MHz linear transducer. Sonographic examination on longitudinal dorsal scan of the metacarpophalangeal joint of the thumb showed a moderate joint cavity widening with two evident bone erosions, one at the metacarpal head and the other one at the basis of the proximal phalanx. The longitudinal volar scan of the first metacarpophalangeal joint confirmed the presence of synovitis detecting a marked joint cavity widening, with aspect of synovial proliferation. The flexor pollicis longus tendon was severely involved (marked tendon sheath widening, synovial proliferation, loss of the normal homogeneous fibrillar echotexture, and a large intratendinous tear). Sonography allowed the depiction of a wide range of otherwise undetectable pathologic changes in the standard clinical setting

Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A systematic literature review and a meta-analysis

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Risk of recurrence after a first episode of symptomatic venous thromboembolism provoked by a transient risk factor: a systematic review.

We aimed to determine the risk of recurrence for symptomatic venous thromboembolism (VTE) provoked by different transient risk factors. DATA SOURCES: MEDLINE, EMBASE, and Cochrane Collaboration Registry of Randomized Trials databases were searched. STUDY SELECTION: Prospective cohort studies and randomized trials of patients with a first episode of symptomatic VTE provoked by a transient risk factor and treated for at least 3 months were identified. DATA EXTRACTION: Number of patients and recurrent VTE during the 0- to 12-month and 0- to 24-month intervals after stopping therapy, study design, and provoking risk factor characteristics were extracted. DATA SYNTHESIS: Annualized recurrence rates were calculated and pooled across studies. At 24 months, the rate of recurrence was 3.3% per patient-year (11 studies, 2268 patients) for all patients with a transient risk factor, 0.7% per patient-year (3 studies, 248 patients) in the subgroup with a surgical factor, and 4.2% per patient-year (3 studies, 509 patients) in the subgroup with a nonsurgical factor. In the same studies, the rate of recurrence after unprovoked VTE was 7.4% per patient-year. The rate ratio for a nonsurgical compared with a surgical factor was 3.0 and for unprovoked thrombosis compared with a nonsurgical factor was 1.8 at 24 months. CONCLUSIONS: The risk of recurrence is low if VTE is provoked by surgery, intermediate if provoked by a nonsurgical risk factor, and high if unprovoked. These risks affect whether patients with VTE should undergo short-term vs indefinite treatment