Measurement properties of radiographic outcome measures in Psoriatic Arthritis: A systematic review from the GRAPPA-OMERACT initiative.

BACKGROUND: Structural damage is as an important outcome in the Psoriatic Arthritis (PsA) Core Domain Set and its assessment is recommended at least once in the development of a new drug. OBJECTIVES: To conduct a systematic review (SR) to identify studies addressing the measurement properties of radiographic outcome instruments for structural damage in PsA and appraise the evidence through the Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Framework Instrument Selection Algorithm (OFISA). METHODS: A SR was conducted using search strategies in EMBASE and MEDLINE to identify full-text English studies which aimed to develop or assess the measurement properties of radiographic outcome instruments in PsA. Determination of eligibility and data extraction was performed independently by two reviewers with input from a third to achieve consensus. Two reviewers assessed the methodology and results of eligible studies and synthesized the evidence using OMERACT methodology. RESULTS: Twelve articles evaluating radiographic instruments were included. The articles assessed nine peripheral (hands, wrists and/or feet) and six axial (spinal and/or sacroiliac joints) radiographic instruments. The peripheral radiographic instruments with some evidence for reliability, cross-sectional construct validity and longitudinal construct validity were the Ratingen and modified Sharp van der Heijde scores. No instruments had evidence for clinical trial discrimination or thresholds of meaning. There was limited evidence for the measurement properties of all identified axial instruments. CONCLUSION: There are significant knowledge gaps in the responsiveness of peripheral radiographic instruments. Axial radiographic instruments require further validation, and the need to generate novel instruments and utilise other imaging modalities should be considered.

Vertebral artery flow and spinal manipulation: a randomized, controlled and observer-blinded study.

BACKGROUND: Several studies have been published on the effect of cervical rotation alone upon blood flow in the vertebral arteries. However, we have not found articles addressing the question of how spinal manipulative therapy per se affects the vertebral artery flow. OBJECTIVE: The aim of the present study was to investigate whether any changes occur in peak flow velocity in the vertebral artery after spinal manipulative therapy as measured using the latest Doppler ultrasound technology. DESIGN AND SETTING: A randomized, controlled and observer-blinded study at a university hospital vascular laboratory. PARTICIPANTS: Twenty university students with a "biomechanical dysfunction" in the cervical spine. RESULTS: We observed no change in peak flow velocity immediately after spinal manipulative therapy and found no correlation between peak flow velocity and systolic blood pressure. CONCLUSION: To the best of our knowledge, this is the first study comparing flow velocity in the vertebral artery before and after spinal manipulative therapy. We found no significant changes in otherwise healthy subjects with a biomechanical dysfunction of the cervical spine. Major changes in peak flow velocity might in theory explain the pathophysiology of cerebrovascular accidents after spinal manipulative therapy. However, in uncomplicated spinal manipulative therapy, this potential risk factor was not prevalent.

Triplex ultrasound of vertebral artery flow during cervical rotation.

BACKGROUND: Reviewing the literature on vertebral artery flow during cervical rotation shows various results. Furthermore, most studies have investigated exclusively the effects of contralateral rotation employing less-than-optimal Doppler ultrasound technique. OBJECTIVE: The aim of this study was to use the latest advancement in Doppler ultrasound technology to investigate flow velocity in the vertebral artery during both ipsilateral and contralateral cervical rotation in normal subjects. DESIGN AND SETTING: A prospective, controlled study in a university hospital vascular laboratory. PARTICIPANTS: Twenty healthy university students. RESULTS: Peak flow velocity decreased significantly during contralateral rotation and increased significantly during ipsilateral rotation. The differences, however, were modest. We found no correlation between peak flow velocity and systolic blood pressure. CONCLUSION: With modern Doppler ultrasound technique, preventing some sources of error in measuring, our finding during contralateral rotation were in accordance with most previous studies showing a decrease in peak flow velocity. For the first time, however, we report an increased flow velocity in the vertebral artery during ipsilateral rotation.