ABSTRACT
Capillaroscopy is a non-invasive and safe tool which allows the evaluation of the morphology of the microcirculation. Since its recent incorporation in the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for systemic sclerosis together with its assessed role to monitor disease progression, capillaroscopy became a 'mainstream' investigation for rheumatologists. Given its increasing use by a variety of physicians internationally both in daily practice to differentiate primary from secondary Raynaud's phenomenon, as well as in research context to predict disease progression and monitor treatment effects, standardisation in capillaroscopic image acquisition and analysis seems paramount. To step forward to this need, experts in the field of capillaroscopy/microcirculation provide in this very consensus paper their view on image acquisition and analysis, different capillaroscopic techniques, normal and abnormal capillaroscopic characteristics and their meaning, scoring systems and reliability of image acquisition and interpretation.
Subject(s)
Microscopic Angioscopy , Nails/blood supply , Raynaud Disease/diagnosis , Scleroderma, Systemic/diagnosis , Humans , Reproducibility of ResultsABSTRACT
OBJECTIVE: The aim of this work was to produce a consensus-based report for capillaroscopy in rheumatology to be used in daily clinical practice. METHODS: A written Delphi questionnaire regarding capillaroscopy report was developed from a literature review and expert consensus. The Delphi questionnaire was sent to an international panel including 25 rheumatologists experts in capillaroscopy, asking them to rate their level of agreement or disagreement with each statement. The exercise consisted of three online rounds and a face-to-face (live meeting) that took place in the PANLAR 2018 congress held in Buenos Aires, Argentina. RESULTS: The participants to the first, second, third, and face-to-face round were 22, 21, 21, and 16 rheumatologists, respectively. Fifty-five items were discussed in the first round, 58 in the second, 22 in the third, and 9 in the face-to-face meeting. At the end of the exercise, 46 recommendations for the capillaroscopy report in rheumatology reached a consensus. CONCLUSION: This is the first consensus-based report in capillaroscopy. It will be useful in daily clinical practice and to address the effort of the standardization in the technique. KEY POINTS: ⢠The current lack of consensus for the capillaroscopy report makes difficult the interpretation of findings as well as follow-up of rheumatic diseases. ⢠This study produced the first international consensus for the format and content of the naifold capillaroscopy report in rheumatology. ⢠The report is an integral part of the capillaroscopy examination and its use in a homogeneous form can help in the correct interpretation of findings in daily practice.
Subject(s)
Microscopic Angioscopy/methods , Nails/blood supply , Rheumatic Diseases/diagnostic imaging , Rheumatology , Consensus , Humans , Nails/diagnostic imagingABSTRACT
La artritis psoriática es una enfermedad inflamatoria crónica y heterogénea que afecta articulaciones, tendones, entesis, piel y uñas. Indudablemente, a lo largo de los últimos años la ecografía se ha ido perfilando como un método de imágenes imprescindible en la práctica cotidiana reumatológica, no sólo por su bajo costo y su mayor sensibilidad respecto al examen físico, sino por la capacidad de detectar compromiso subclínico y permitir el monitoreo de la evolución de la enfermedad. El incesante crecimiento tecnológico orientado al diseño de equipos dotados de sondas de alta frecuencia y módulos power Doppler altamente sensibles permite actualmente apreciar alteraciones morfo-estructurales con una resolución inferior al décimo de milímetro, y detectar el mínimo flujo sanguíneo presente en los microvasos de los tejidos superficiales. No obstante estas ventajas, aún son pocos los estudios que demuestran la utilidad de la ecografía en la artritis psoriática. El objetivo principal de esta revisión es demostrar el potencial actual de la ecografía en el estudio de pacientes con artritis psoriática mediante la ilustración de alteraciones a nivel de articulaciones, tendones, entesis, piel y uñas.
Psoriatic arthritis (PsA) is a chronic and heterogeneous inflammatory disease that involves joints, tendons, enthesis, skin and nails. Without doubt, ultrasound has become a rapidly evolving technique that is gaining more and more importance among rheumatologists. The continuous technological advances in the field of ultrasound has allowed the development of equipment provided with high and variable frequency probes and very sensitive power Doppler, which permit both the detailed study (with resolution power of 0.1 mm) of morphostructural changes and the sensitive detection of blood flow, even in small vessels of superficial tissues. To date most of the studies have been aimed at investigating its capacity in the assessment of joints, tendons and entheses in psoriatic arthritis patients. Less attention has been paid to demonstrate the potential of ultrasound in the evaluation of skin and nails.The aim of this study is to show the main high frequency greyscale and power Doppler ultrasound findings in patients with psoriatic arthritis at joint, tendon, enthesis, skin and nail level.
Subject(s)
Humans , Arthritis, Psoriatic , Ultrasonography, Doppler , Joints/pathology , Joints , Arthritis, Psoriatic/pathology , Tendons/pathology , Tendons , Nails/pathology , NailsABSTRACT
Introducción: La información referente al pronóstico de la epilepsia es heterogénea. Estudiamos retroprospectivamente los factores asociados a la remisión de crisis epilépticas en los pacientes del Servicio de Neurología del Hospital Belén de Trujillo. Método: Se entrevistaron a 80 epilépticos adultos que habían recibido por lo menos un año de tratamiento antoconvulsivante; y se los agrupó según alcanzaron o no remisión de crisis durante un periodo de un año o más. Resultados: La frecuencia de remisión de crisis fue 29 por ciento. La remisión de crisis epilépticas estuvo asociada a la ausencia de factores precipitantes de crisis y de enfermedades neurológicas que afectan el control de las crisis. No hubo asociación entre la remisión de crisis y tipo de crisis, número de crisis antes de la terapia farmacológica, etiología de la epilepsia, respuesta de las crisis a la primera droga anticonvulsivante y cumplimiento con el regimen farmacológico. El motivo de incumplimiento con el régimen farmacológico más frecuente fue el costo de las drogas (33 por ciento). Los factores precipitantes de crisis más frecuentes fueron los estímulos sensoriales (52 por ciento). Conclusiones: La remisión de crisis epiléptoicas estuvo asociada a la ausencia de factores precipitantes de crisis y deenfermedades que afectan el control de las crisis.
