Spondylodiscitis desease evaluation in patients with seronegativespondyloarthropathies

Spondylodiscitis [SD] is a destructive discovertebral lesion which is uncommon, but well recognised as a complication of Ankylosing Spondylitis [AS], and also called the Andersson lesion. This prospective study described 24 cases of AS, 12 of them with SD with variable clinical presentation and radiological appearance [SD]. Two had multiple lesions, in one patient spondylodiscitis was the presenting symptom of AS. None had a history of even a minor trauma and radiological appearance of Andersson lesion in AS. In a prospective analysis of 24 patients with ankylosing spondylitis [AS] with multiple nationalities, 12 individuals [50%] had spondylodiscitis, affecting the spine at various levels, we described the demoaphic data, full medical history, clinical examination and radiological findings including thoracolumbar spinal magnetic resonance imaging [MRI] in all patients diagnosed as SD with AS admitted to our department. All patients were fulfilling the modified New York criteria and ASAS criteria for AS. The results showed that the mean age of patients was 43 +/- 10.8 yrs, 16 [66.667%] were males. Half of the 12 patients had multiple lesions [between two and six levels]. Mean disease duration were 11+/-8.7. The most common Site of lesion was the thoracic spine. The prognosis was good with conservative treatment including NSAID's, rest, and physiotherapy. The literature was reviewed regarding the mechanisms that may contribute to these lesions: mainly inflammatory like increasing enthesopathy or mainly mechanical like pseudoarthrosis about a fracture site. It might be that both mechanisms could result in similar destructive intervertebral disc lesions

Value of MRI and inflammatory markers in assessment of erosive osteoarthritis hand

To investigate the role of MRI and inflammatory markers [serum C reactive protein [CRP] as a marker of erosive osteoarthritis [EOA] of the hand. Thirty three patients, 22 with EOA and 11 with non-EOA of the hand, were included in the study and analysed for radiographic score [RS], number of erosions, and joint count [JC] at clinical observation and at MRI CRP was assayed in a serum sample by a highly sensitive immunonephelometric method. The median [interquartile range] CRP level was 5.2[2.7-7.2] mg/l in the EOA and 2.8 [0.7-5.2] mg/I in the non-EOA group [p = 0.001]. In all patients, CRP correlated with RS [p<0.001], and mainly with JC at clinical observation [p<0.001] and MRI [p<0.001]. The correlation of CRP with RS and JC was confirmed at clinical observation and at MRI in the EOA subgroup, but only with JC at clinical observation in the non-EOA subgroup. CRP levels are higher in EOA than in non-EoA patients. These levels probably reflect the disease activity of EOA, as suggested by correlations between CRP and JC at clinical observation and MRI. BMI, body mass index; CRP, C reactive protein; EOA, erosive osteoarthritis; ESR, erythrocyte sedimentation rate; hsCRP, high sensitivity CRP; MRI, Magnetic Resonance Imaging; IL, interleukin; JC, joint count; OA, osteoarthritis; RS, radiographic score

Independent associations of anti-cyclic citrullinated peptide antibodies and rheumatoid factor with radiographic severity of rheumatoid arthritis

Recent studies have established a strong association between anti-cyclic citrullinated peptide antibody [anti-CCP] positive rheumatoid arthritis [RA] and carriage of shared epitope [SE] alleles. Although anti-CCP have also been associated with more severe RA, the issue of whether this is independent of rheumatoid factor [RF] has not been addressed. To indentify associations between RF, anti-CCP, SE status and radiological damage, we studied a large cross-sectional cohort with longstanding RA. Individuals [n=100] enrolled in the study all fulfilled the American College of Rheumatology criteria for RA had a minimum disease duration of 4 years, and at least one definite radiographic erosion was present in hands or feet. Radiographs were scored blind at study entry by a single musculoskeletal radiologist using a modified Larsen's score, Anti-CCP and RF levels were determined using enzyme-linked immunosorbent assay, and DRBI typing was performed using polymerase chain reaction based methodology. Both anti-CCP and RF status, evidence of independent associated with radiographic severity [P<0.0001]. In subgroups stratified for both anti-CCP and RF status, evidence of independent associations of both antibodies with radiographic outcome was found [P<0.0001]. An association of SE alleles playing at most a secondary role. Our study support the view that previously described associations between SE and radiological severity, especially in RF-negative patients, may be indirect and due to an association with anti-CCP

Evaluation of tuberculosis versus pyogenic [infectious] arthritis by using MRI imaging

To assess magnetic resonance [MR] imaging features in differentiating tuberculous arthritis from pyogenic arthritis. Findings in 29 patients with tuberculous arthritis were compared with those of 13 patients with pyogenic arthritis. Bone erosion, marrow signal intensity, synovial lesion signal intensity, boundaries [smooth or irregular] for extraarticular extension of infection, and abscess rim enhancement [thin and smooth or thick and irregular] were analyzed. Revealed that bone erosion was more common in patients with tuberculous arthritis [24 [83%] of 29] than in those with pyogenic arthritis [six [46%] of 13] [P = 0.026], while subchondral marrow signal intensity abnormality was seen more frequently in patients with pyogenic arthritis [12 [92%] of 13] than in those with tuberculous arthritis [17 [59%] of 29] [P = 0.036]. On T2-weighted images, there was no significant difference between the synovial lesion signal intensities of tuberculous arthritis and pyogenic arthritis. Lesions in 16 [70%] of 23 patients with tuberculous arthritis and two [17%] of 12 patients with pyogenic arthritis had smooth extraarticular boundaries, while those in seven [30%] of 23 patients with tuberculous arthritis and 10 [83%] of 12 patients with pyogenic arthritis had irregular boundaries [P = .005]. Tuberculous abscesses [16 [100%] of 16] had thin and smooth rim enhancement, while most pyogenic abscesses [five [7 1%] of seven] had thick and irregular rims[P .001].MR imaging of bone abnormalities Tnalities, extraarticular lesions, and associated abscesses provides useful information in the differentiation of tuberculous arthritis and pyogenic arthritis