Deletion of LCE3C and LCE3B is a susceptibility factor for psoriatic arthritis: a study in Spanish and Italian populations and meta-analysis.

OBJECTIVE: The LCE3C_LCE3B-del variant is associated with psoriasis and rheumatoid arthritis. Its role in psoriatic arthritis (PsA) is unclear, however, as shown by 3 recent studies with contradictory results. In order to investigate whether LCE3C_LCE3B-del constitutes a risk factor for PsA susceptibility, we first tested this variant in patients with PsA from Spanish and Italian populations and then performed a meta-analysis including the previous case-control studies. METHODS: We genotyped LCE3C_LCE3B-del and its tag single-nucleotide polymorphism (SNP), rs4112788, in an original discovery cohort of 424 Italian patients with PsA and 450 unaffected control subjects. A Spanish replication cohort consisting of 225 patients with PsA and 469 control subjects was also genotyped. A meta-analysis considering 7,758 control subjects and 2,325 patients with PsA was also performed. RESULTS: We observed a significant association between PsA and the LCE3C_LCE3B-del tag SNP in the Italian and Spanish cohorts, with an overall corrected P value of 0.00019 and a corresponding odds ratio of 1.35 (95% confidence interval 1.14-1.59). Stratified analyses by subphenotype indicated a stronger association for patients with oligoarticular disease. Meta-analysis including data from all previous published studies confirmed an association of PsA with the LCE3C_LCE3B-del tag SNP. CONCLUSION: LCE3C_LCE3B-del is a susceptibility factor for PsA, confirming the existence of a shared risk factor involving the epidermal skin barrier in autoimmune disorders.

Rapid reduction in tenosynovitis of the wrist and fingers evaluated by MRI in patients with rheumatoid arthritis after treatment with etanercept.

OBJECTIVE: To assess the efficacy of etanercept in reducing tenosynovitis evaluated by MRI of the hand (h-MRI) in patients with active rheumatoid arthritis (RA) refractory to disease-modifying antirheumatic drug (DMARD) after 6 weeks of treatment. METHODS: 31 patients with active RA defined by a disease activity score (DAS28) >3.2 and synovitis in the hands were randomised into two groups: 19 patients received 50 mg weekly subcutaneous etanercept added to previous DMARD treatment and 12 patients continued with previous DMARD therapy. Clinical evaluation, blood tests, functional capacity evaluation and h-MRI were performed at the start of the investigation and at week 6. Tenosynovitis was evaluated on T1-weighted sequences with fat suppression after gadolinium as the presence of a peritendinous signal enhancement on axial images using a new method including wrist and finger tendons. The reliability, sensitivity to change and responsiveness of this method were also evaluated. RESULTS: Scores for tenosynovitis showed a significant reduction in the etanercept group compared with placebo (p=0.01) after 6 weeks of treatment. Adding MRI joint synovitis to tenosynovitis scores gave an even higher significant reduction in the etanercept group (p=0.007). A positive and statistically significant correlation between tenosynovitis and DAS28, erythrocyte sedimentation rate and C-reactive protein was found, but not with functional capacity. Responsiveness for tenosynovitis was small but was higher when joint synovitis scores were added. CONCLUSION: Addition of etanercept significantly reduced MRI tenosynovitis of the wrist and fingers in patients with active RA refractory to DMARD treatment. The method of scoring tenosynovitis showed good reliability and moderate responsiveness.

[Efficacy of gabapentin in the treatment of carpal tunnel syndrome]. / Eficacia de la gabapentina en el tratamiento del síndrome del túnel carpiano.

BACKGROUND AND OBJECTIVE: To evaluate the analgesic efficacy and safety of gabapentin in the treatment of carpal tunnel syndrome (CTS), as well as the electromyographic (EMG) evolution after 6 months. PATIENTS AND METHOD: A prospective study with a 6-month follow-up of patients with EMG diagnosis of primary CTS starting treatment with 1.800 mg/day of gabapentin. At baseline visit and after 6 months of treatment a complete clinical evaluation and an EMG study were performed. Adverse effects of gabapentin were also registered. RESULTS: Twenty-five patients were included, mean age (standard deviation) 58.88 (7.69) years. After 6 months of treatment, a statistically significant reduction of pain (p = 0.001) and improvement of severity of symptoms (p = 0.008) were observed, although functional capacity did not change. EMG was performed in 19 patients at 6 months. Compared to baseline EMG: 52.6% patients showed no changes in EMG findings, while 5.3% patients showed improvement and in 26.3% the EMG was normal. Progression was only seen in 15.8% of patients after 6 months of treatment. In 28% of the patients gabapentin was stopped because of side effects. CONCLUSIONS: In our series, gabapentin was effective in the reduction of pain and improvement of the severity of the symptoms. Results of EMG after 6 months of treatment showed no changes, with improvement and/or remission in 84.2% of the cases. The drug was safe and well tolerated.

Eficacia de la gabapentina en el tratamiento del síndrome del túnel carpiano / Efficacy of gabapentin in the treatment of carpal tunnel syndrome

Fundamento y objetivo: Evaluar la eficacia analgésica y la seguridad de la gabapentina en el tratamiento del síndrome del túnel carpiano (STC), así como la evolución electromiográfica (EMG) a los 6 meses. Pacientes y método: Estudio prospectivo de 6 meses de duración en los pacientes con diagnóstico EMG de STC primario en tratamiento con gabapentina a dosis de 1.800 mg/día. En la visita basal y a los 6 meses se realizaron valoración clínica, exploración y EMG, y se registraron los efectos adversos. Resultados: Se incluyó en el estudio a 25 pacientes con una edad media (desviación estándar) de 58,88 (7,69) años. A los 6 meses se observó una reducción del dolor (p = 0,001) y de la intensidad de los síntomas (p = 0,008), sin cambios en la capacidad funcional. El EMG se realizó a los 6 meses en 19 pacientes, de los que no se observaron cambios respecto a EMG basal en un 52,6%, se apreció mejoría en un 5,3%, progresión en un 15,8% y curación en un 26,3%. En un 28% se retiró el tratamiento por efecto adverso. Conclusiones: En nuestra serie la gabapentina fue eficaz en la reducción del dolor y en la mejoría de la intensidad de los síntomas. El EMG a los 6 meses de tratamiento demostró estabilidad, mejoría y/o curación en el 84,2% de los casos. La gabapentina resultó segura y bien tolerada

Background and objective: To evaluate the analgesic efficacy and safety of gabapentin in the treatment of carpal tunnel syndrome (CTS), as well as the electromyographic (EMG) evolution after 6 months. Patients and method: A prospective study with a 6-month follow-up of patients with EMG diagnosis of primary CTS starting treatment with 1.800 mg/day of gabapentin. At baseline visit and after 6 months of treatment a complete clinical evaluation and an EMG study were performed. Adverse effects of gabapentin were also registered. Results: Twenty-five patients were included, mean age (standard deviation) 58.88 (7.69) years. After 6 months of treatment, a statistically significant reduction of pain (p = 0.001) and improvement of severity of symptoms (p = 0.008) were observed, although functional capacity did not change. EMG was performed in 19 patients at 6 months. Compared to baseline EMG: 52.6% patients showed no changes in EMG findings, while 5.3% patients showed improvement and in 26.3% the EMG was normal. Progression was only seen in 15.8% of patients after 6 months of treatment. In 28% of the patients gabapentin was stopped because of side effects. Conclusions: In our series, gabapentin was effective in the reduction of pain and improvement of the severity of the symptoms. Results of EMG after 6 months of treatment showed no changes, with improvement and/or remission in 84.2% of the cases. The drug was safe and well tolerated

Resonancia magnética de la mano en la artritis reumatoide. Revisión de la metodología y la utilidad en el diagnóstico, el seguimiento y el pronóstico / Magnetic resonance of the hand in rheumatoid arthritis. Review of methodology, and its use in diagnosis, monitoring and prognosis

El objetivo ideal del tratamiento en la artritis reumatoide (AR) es la supresión de la inflamación y evitar el daño estructural articular. Para medir la progresión de las lesiones estructurales en la AR disponemos de la radiología de las manos y los pies, que es el método tradicional. Sin embargo, la radiología sólo permite evaluar la alteración ósea (erosiones) e indirectamente el cartílago articular. Por ello, la resonancia magnética de las manos (RMm) presenta ciertas ventajas al permitir el estudio no sólo de la cortical ósea y el hueso medular, sino también de la membrana sinovial, las estructuras tendinoligamentosas y los tejidos blandos adyacentes, que suelen ser las estructuras que se afectan al inicio de la enfermedad. Además se ha demostrado más sensible que la radiología en la detección precoz de erosiones y en la predicción del daño óseo, lo que permite un rápido diagnóstico, instaurar un tratamiento adecuado y mejorar el pronóstico de los pacientes (AU)

The ideal aim of treatment in rheumatoid arthritis (RA) is to suppress synovial inflammation and to stop or reduce structural joint damage progression. To evaluate joint damage in RA, radiographic assessment of hands and feet is the traditional method. Nevertheless, plain film radiography can only evaluate bone damage (erosion) and, indirectly, joint cartilage. Magnetic resonance imaging presents important advantages since allows to study, not only the cortical bone and the marrow, but also the synovial membrane, tendon and ligament structures, and adjacent soft tissue that usually are involved in early disease. Moreover, hand-magnetic resonance (h-MRI) has shown to be more sensitive than plain radiography in detecting early erosions and predicting progression of bone damage, allowing a rapid diagnosis and to start the most efficient therapy as well as to achieve better outcomes for this disease (AU)