Validity of enthesis ultrasound assessment in spondyloarthropathy.

OBJECTIVES: To develop an ultrasound enthesis score and to assess its validity in the diagnostic classification of the spondyloarthropathies (SpAs). METHODS: Twenty-five patients with SpA and 29 healthy controls participated in a blinded, gender-matched, cross-sectional study involving ultrasound assessment. The following entheses were explored bilaterally: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligament, distal quadriceps and brachial triceps tendons. The ultrasound score evaluated enthesis thickness, structure, calcifications, erosions, bursae and power Doppler signal. The value of each elemental lesion was calculated using a three-model analysis. Validity was analysed by receiver operating characteristic (ROC) curves. Inter-reader and interexplorer intraclass correlation coefficients (ICCs) were calculated. RESULTS: The logistic regression model overestimated the score of three elemental lesions: calcification (0-3), Doppler (0 or 3) and erosion (0 or 3), while scoring tendon structure, tendon thickness and bursa as 0 or 1. ROC curves established an ultrasound score of >or=18 as the best cut-off point for differentiation between cases and controls. This cut-off point was exceeded by 5/29 controls (17%) and by 21/25 patients with SpA (84%). The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-) were 83.3%, 82.8%, 4.8% and 0.2%, respectively. The inter-reader and interexplorer ICCs were 0.60 and 0.86, respectively. CONCLUSION: The findings suggest that the ultrasound enthesis score could be a valid tool in the diagnosis of SpA.

Grado de conocimiento de la osteoporosis en mujeres posmenopáusicas / No disponible

En enfermedades asintomáticas como la osteoporosis es especialmente importante que las pacientes conozcan la enfermedad, sus tratamientos y las pautas de vidanecesarias para prevenir de ese modo las posibles fracturas y sus consecuencias. En un estudio observacional, prospectivo, multicéntrico, comparativo y abierto de 12 meses de duración para evaluar el cumplimiento, como objetivo secundario del estudio se analizó el grado de conocimiento de la enfermedad mediante la prueba de Batalla, modificada para la osteoporosis. Los resultaron mostraron que, globalmente, el 49,3% de las pacientes tenía un conocimientoaceptable de la enfermedad, el 14,3% medianamente aceptable y en un 36,5% era inaceptable. Por tanto, si bien el grado de conocimiento de la osteoporosisen mujeres posmenopáusicas españolas fue aceptable, el conocimiento de esta enfermedad es todavía deficiente en más del 50%, por lo que es necesario continuaraumentando el conocimiento de la enfermedad en esta población

In asymptomatic diseases such as osteoporosis, it is especially important for the patients to know about the disease, its treatment and the life guidelines necessaryto prevent this method of possible fractures and their consequences. In an observational, prospective, multicenter, comparative and open label 12 monthlong study to evaluate compliance, as a secondary objective of the study, grade of knowledge of the disease was evaluated to study compliance using theBatalla test, modified for osteoporosis. The results showed that, overall, 49.3% of the patients had acceptable knowledge about the disease, 14.3% somewhatacceptable and 36.5% unacceptable knowledge. Thus, although the grade of knowledge on osteoporosis in postmenopausal Spanish women was accepted,knowledge on osteoporosis is still deficient in more than 50%. Thus, it is necessary to continue to increase knowledge about the disease in this population

Arthroscopic lavage treatment in rheumatoid arthritis of the knee.

OBJECTIVE: To assess the efficacy of outpatient arthroscopic lavage in rheumatoid arthritis (RA) of the knee. METHODS: 9 patients with RA and active synovitis of at least one knee were selected. All patients were taking disease modifying antirheumatic drugs and nonsteroidal antiinflammatory drugs and had failed intraarticular corticosteroid injection of the knee. Using the 1.9 mm office arthroscope and strict sterile technique the affected knee was lavaged with at least 750 cc of normal saline. At the end of the procedure 40 mg triamcinolone acetonide was injected through the arthroscope. Assessment was done at baseline and 4, 8, and 12 weeks after the lavage using a visual analog scale for pain and 50 foot walk time. RESULTS: 8 of the 9 patients showed marked improvement in their pain and walk time. This effect was maintained at least 12 weeks after the procedure. CONCLUSION: Office arthroscopic lavage treatment is beneficial in a selected group of patients. This procedure is simple and well tolerated without major complications, and may be an option when more conservative therapies have failed.