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Philip G. Conaghan - One of the best experts on this subject based on the ideXlab platform.

  • eular recommendations for the use of imaging in the clinical management of Peripheral Joint osteoarthritis
    Annals of the Rheumatic Diseases, 2017
    Co-Authors: Garifallia Sakellariou, Philip G. Conaghan, Weiya Zhang, Johannes W J Bijlsma, Pernille Boyesen, Maria Antonietta Dagostino, Michael Doherty, Daniela Fodor, M Kloppenburg, Falk Miese
    Abstract:

    The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.

  • a systematic review of the relationship between subchondral bone features pain and structural pathology in Peripheral Joint osteoarthritis
    Arthritis Research & Therapy, 2015
    Co-Authors: Andrew Barr, Mark T Campbell, Devan Hopkinson, Sarah R Kingsbury, M A Bowes, Philip G. Conaghan
    Abstract:

    Introduction: Bone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional radiographic imaging of subchondral bone, pain, structural pathology and Joint replacement in Peripheral Joint OA. Methods: A search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and Joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Each association was qualitatively characterised by a synthesis of the data from each analysis based upon study design, adequacy of covariate adjustment and quality scoring. Results: In total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). BMLs, osteophytes and bone shape were independently associated with structural progression or Joint replacement. BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively. Conclusion: Subchondral bone features have independent associations with structural progression, pain and Joint replacement in Peripheral OA in the hip and hand but especially in the knee. For Peripheral OA sites other than the knee, there are fewer associations and independent associations of bone pathologies with these important OA outcomes which may reflect fewer studies; for example the foot and ankle were poorly studied. Subchondral OA bone appears to be a relevant therapeutic target. Systematic review: PROSPERO registration number: CRD 42013005009

  • The role of imaging modalities in the diagnosis, differential diagnosis and clinical assessment of Peripheral Joint osteoarthritis.
    Osteoarthritis and cartilage, 2014
    Co-Authors: Claire Y. J. Wenham, Andrew J. Grainger, Philip G. Conaghan
    Abstract:

    Peripheral Joint osteoarthritis (OA) is predominantly a clinical diagnosis, though imaging may provide confirmation and aid with differential diagnosis where there is clinical doubt. Whilst radiographs (X-rays (XR)) are usually the first-line imaging modality selected, magnetic resonance imaging (MRI), ultrasound and computed tomography (CT) may all have a valuable role in assessing a person with OA, although each has its particular advantages and disadvantages. MRI is of particular use for diagnosing bone conditions that may cause a rapid increase in symptoms, such as avascular necrosis (AVN) or a subchondral insufficiency fracture (SIF), while providing concomitant soft tissue assessment. Ultrasound offers rapid assessment of Peripheral Joints and can easily assess for features of inflammatory arthritis. CT is faster to perform than MRI and can also image the subchondral bone, but does involve ionising radiation. Selecting the correct imaging modality, in the context of its advantages when visualising a specific Joint (e.g., hand vs knee) and with clinical context in mind, will enhance the added value of imaging in clinical practice.

Neil Mchugh - One of the best experts on this subject based on the ideXlab platform.

  • Drug therapies for Peripheral Joint disease in psoriatic arthritis: a systematic review.
    The Journal of rheumatology, 2014
    Co-Authors: Maria Laura Acosta Felquer, Neil Mchugh, Oliver Fitzgerald, Laura C Coates, Enrique R Soriano, Roberto Ranza, Luis R Espinoza, Philip S Helliwell, Euthalia Roussou, Philip J Mease
    Abstract:

    In 2009, GRAPPA published their first evidence-based recommendations for the treatment of psoriasis and psoriatic arthritis (PsA). Since then, new information has been published and drugs developed. We summarize evidence for the efficacy of available treatments for Peripheral Joint involvement in PsA. We performed a systematic review of current literature on the efficacy of different therapies, management, and therapeutic strategies for Peripheral arthritis involvement in PsA, in order to provide information for the development of the new GRAPPA treatment recommendations.

  • therapies for Peripheral Joint disease in psoriatic arthritis a systematic review
    The Journal of Rheumatology, 2014
    Co-Authors: Enrique R Soriano, Neil Mchugh
    Abstract:

    Traditional drug treatments for psoriatic arthritis (PsA) include nonsteroidal antiinflammatory agents (NSAID) and disease modifying antirheumatic drugs (DMARD), although the evidence base for their effectiveness is not well established. This review was compiled from a comprehensive literature search of electronic bibliographic databases for all English publications that were systematic reviews, metaanalyses, randomized controlled trials, controlled trials, and observational studies. The evidence supports NSAID for symptom relief, although data are lacking for COX-2-specific agents. No evidence exists to support systemic corticosteroids or corticosteroids by intraarticular injection, although the latter are commonly used in clinical practice. Among traditional DMARD, grade 1B evidence supports sulfasalazine, cyclosporine, and leflunomide for symptom relief, with lower-grade evidence for methotrexate. None of them slows radiographic progression. Grade 1B evidence supports improvement in symptoms, physical function, quality of life, and radiographic progression with anti-TNF antagonists (etanercept, infliximab, and adalimumab). The relative lack of evidence poses challenges in developing algorithms for treatment of Peripheral arthritis in PsA.

  • Treatment Algorithms for Early Psoriatic Arthritis: Do They Depend on Disease Phenotype?
    Current Rheumatology Reports, 2012
    Co-Authors: William Tillett, Neil Mchugh
    Abstract:

    Psoriatic arthritis is a distinct inflammatory arthritis associated with psoriasis and characterized by a broad clinical phenotype. Associated with skin disease, patients may have differing patterns of Peripheral Joint disease, spondyloarthritis, enthesitis, dactylitis, and nail disease with overlap and transition between phenotypes. Research over the past decade has resulted in a wealth of data to guide management, and several treatment algorithms have recently been published with varying emphasis on disease phenotype. This review discusses the incorporation of phenotype in the treatment of early disease, with extended discussion of current research and new concepts in disease measurement that will impact the development of future algorithms.

  • developing classification criteria for Peripheral Joint psoriatic arthritis step i establishing whether the rheumatologist s opinion on the diagnosis can be used as the gold standard
    The Journal of Rheumatology, 2006
    Co-Authors: Deborah P M Symmons, Neil Mchugh, Philip S Helliwell, Mark Lunt, Gillian Watkins, Sharon Jones, Douglas J Veale
    Abstract:

    OBJECTIVE: The study of psoriatic arthritis (PsA) is hampered by the absence of a widely accepted, validated case definition. We investigated whether the physician's opinion can be used as a gold standard when developing classification criteria for Peripheral Joint PsA. METHODS: UK rheumatologists who had published on PsA and attendees at 3 international meetings on PsA held in the UK were polled by questionnaire. There were 3 phases. The first questionnaire asked whether rheumatologists believed in the construct of PsA. The second survey developed a list of features thought to distinguish patients with PsA from other forms of Peripheral arthritis. The final phase was development of a series of 61 "paper" patients with various combinations of the features of PsA. The paper patients were assessed by 15 rheumatologists who were asked whether, in their opinion, the patient had PsA. Latent class analysis was used to identify subgroups of patients and cross-tabulations were used to identify which clinical and laboratory features were associated with each subgroup. RESULTS: Rheumatologists agreed on the construct of PsA and that not all patients with psoriasis and an inflammatory polyarthritis have PsA. Latent class analysis identified 3 classes, corresponding to definite PsA; a middle group that was very likely to be given a diagnosis of PsA by some rheumatologists (high diagnosers), but unlikely to be given the diagnosis by others (low diagnosers); and a third group corresponding to "probably not PsA." CONCLUSION: For the group of patients with "definite PsA" the physician's opinion can be taken as the gold standard when developing classification criteria. However, for patients in the "middle group" there will always be disagreement with the gold standard whether the standard is based on the opinion of the high diagnosers or the low diagnosers.

  • progression of Peripheral Joint disease in psoriatic arthritis a 5 yr prospective study
    Rheumatology, 2003
    Co-Authors: Neil Mchugh, C Balachrishnan, S M Jones
    Abstract:

    Objective. To assess the evolution of disease subgroups and the frequency of progression of Peripheral Joint disease in a prospectively studied cohort of patients with psoriatic arthritis (PsA). Methods. The cohort was identified as the first consecutive 100 patients attending a psoriatic arthritis clinic and who had been the subject of a previously published cross-sectional retrospective study. Nine of the 100 patients had died, three declined follow-up and one could not be traced. The remaining 87 patients (49 females, 38 males) completed the study proforma at a median follow-up interval of 65 months (range 39‐90). An analysis of initial plasma viscosity compared with rates of progression of Joint score was performed. Results. Eighteen patients changed subgroup; 11 had an increase in the number of Joints involved, six a decrease, and one changed from an oligoarticular pattern to predominant spondylitis. Within the polyarticular group 37u51 patients had an increase in the number of Joints involved. For the whole population, there were significant increases in the number of Joints involved (median 6 vs 11, P < 0.001 Wilcoxon signed rank) and Health Assessment Questionnaire scores (median 0.375 vs 0.5, P < 0.001). The median rate of Joint progression was 0.42 Peripheral Joints per year (range 0‐7.2). However, the rate of Peripheral Joint involvement was highest in the first year of arthritis (median 4.0 Jointsuyr) as measured in 13 patients who had onset within 12 months of baseline assessment. There were no significant differences in skin and nail scores although nine more patients had developed nail disease. There was a significant correlation between the initial viscosity and rate of progression of Joint damage (Spearman correlation, P < 0.011). Conclusions. Peripheral Joint disease is progressive in the majority of patients with PsA and reinforces the need for effective monitoring and treatment.

Dominique Baeten - One of the best experts on this subject based on the ideXlab platform.

  • Peripheral Joint inflammation in early onset spondyloarthritis is not specifically related to enthesitis
    Annals of the Rheumatic Diseases, 2014
    Co-Authors: Jacqueline E Paramarta, Christiaan Van Der Leij, Ioana Gofita, Nataliya Yeremenko, Marleen G H Van De Sande, Maria J H De Hair, Paul P Tak, Mario Maas, Dominique Baeten
    Abstract:

    Objectives A pivotal MRI study of knee arthritis indicated that enthesitis was more frequently observed in established spondyloartritis (SpA) than rheumatoid arthritis (RA). Subsequent MRI and ultrasound studies, however, failed to consistently demonstrate primary synovitis in RA versus primary enthesitis in SpA. Therefore, the current study aimed to reassess enthesitis versus synovitis in Peripheral arthritis by a combined imaging and histopathological study in early untreated disease. Methods MRI and mini-arthroscopic synovial biopsy sampling were performed in 41 patients with early untreated knee or ankle arthritis, who were diagnosed with SpA (n=13), RA (n=20) or crystal arthropathy (n=8) at follow-up. MRI evaluation of enthesitis and synovitis, and immunohistochemical characterisation of synovitis were performed by two observers blinded to diagnosis. Results MRI showed similar prevalence of perientheseal fluid/oedema (67% vs 75%), perientheseal bone marrow oedema (0% vs 10%) and entheseal enhancement (46% vs 47%) in SpA versus RA, respectively. The number and distribution of affected entheseal sites were not different between both diseases. The MRI synovitis score was significantly higher in SpA (median 1.4; IQR 1.1–1.5) compared with RA (median 0.5; IQR 0.0–1.3) (p=0.028). Synovial histopathology showed a numerical increase in infiltrating cells in SpA versus RA synovitis which reached significance for CD163 macrophages in the synovial sublining (p=0.030). There were no differences compared with the crystal arthropathy control group. Conclusions Enthesitis on MRI is not a specific feature of Peripheral arthritis in recent onset SpA versus RA. Synovitis is prominent in both diseases as evaluated by MRI and immunohistochemistry.

  • Immunomodulatory effects of etanercept on Peripheral Joint synovitis in the spondylarthropathies.
    Arthritis and rheumatism, 2005
    Co-Authors: E Kruithof, Leen De Rycke, Johannes Roth, Herman Mielants, Filip Van Den Bosch, Filip De Keyser, Eric Veys, Dominique Baeten
    Abstract:

    Objective Because different tumor necrosis factor α (TNFα) blockers may have distinct immunomodulatory effects on specific disease manifestations, the present study was carried out to investigate the immunomodulating effects of etanercept on Peripheral synovitis in the spondylarthropathies (SpA). Methods Peripheral Joint disease was assessed clinically, histologically, and radiologically in a prospective 2-year study of 20 patients with SpA treated with etanercept. Synovial tissue biopsy samples obtained at weeks 0, 12, and 52 were analyzed by histology and immunohistochemistry for the extent of inflammation, changes to tissue architecture, and matrix degradation. Serum levels of myeloid-related protein 8 (MRP-8)/MRP-14, matrix metalloproteinase 3 (MMP-3), and cartilage oligomeric matrix protein (COMP) were determined by enzyme-linked immunosorbent assay. Results Etanercept induced a rapid and sustained clinical improvement of Peripheral Joint disease. Histologic synovitis was down-regulated, with a profound reduction in global cellular infiltration and T lymphocytes, but not B lymphocytes. The most prominent change in markers of inflammation was a reduction in the different macrophage subsets (CD68, CD163, MRP-8, and MRP-14), but this was not paralleled by a decrease in serum MRP-8/MRP-14. Structural changes included normalization of lining layer hyperplasia and a moderate reduction in vascularity. However, no effect on the microarchitecture of lymphoid aggregates was observed. In terms of an effect on matrix degradation, the synovial expression of MMP-3 and MMP-9 was down-modulated in correlation with a rapid and profound decrease in serum MMP-3. At week 52, serum COMP levels were also reduced. No significant radiologic disease progression was observed in these patients over a 2-year period. Conclusion Use of etanercept effectively down-modulated the immunopathologic processes of SpA synovitis, both in the short term and in the long term.

Dafna D. Gladman - One of the best experts on this subject based on the ideXlab platform.

  • patterns of Peripheral Joint involvement in psoriatic arthritis symmetric ray and or row
    Seminars in Arthritis and Rheumatism, 2018
    Co-Authors: Vinod Chandran, Lynne Stecher, Vern Farewell, Dafna D. Gladman
    Abstract:

    Abstract Objective We sought to examine whether Joint involvement in psoriatic arthritis (PsA) follows a symmetric, ray, and/or row pattern using longitudinal data. Methods Data on activity and clinical damage of the Joints of the hands and feet were obtained from a PsA cohort. For each analysis (symmetry, ray or row) for each outcome (Joint damage and activity) expected values for table cells under the null hypothesis that Joints progress independently to damage or activity were calculated based on a logistic regression model with patient level random effects for the probability of involvement developing between clinic visits. To determine the consistency of observed with expected values, goodness-of-fit tests were performed. Results Data from 704 patients were available. The 511 (552) patients with no hand (foot) damage at clinic entry were used for analyses of hand (foot) damage. When considering Joint damage, there was strong evidence against independence of Joint involvement based on evident symmetric patterns. There was little suggestion of ray patterns of Joint damage. There was considerable evidence for row pattern of involvement of Joints. When considering Joint activity, symmetric patterns were also evident but, unlike Joint damage, there was evidence of ray patterns, most notably in the hands. There was also evidence for row pattern involvement. Conclusion Patterns of Peripheral Joint involvement seen over time in PsA patients, demonstrate consistency with expected ray patterns of disease activity, especially in the hands, but there is also considerable evidence for symmetric and row patterns for both Joint damage and activity.

  • Patterns of Peripheral Joint involvement in psoriatic arthritis—Symmetric, ray and/or row?
    Seminars in arthritis and rheumatism, 2018
    Co-Authors: Vinod Chandran, Lynne Stecher, Vern Farewell, Dafna D. Gladman
    Abstract:

    Abstract Objective We sought to examine whether Joint involvement in psoriatic arthritis (PsA) follows a symmetric, ray, and/or row pattern using longitudinal data. Methods Data on activity and clinical damage of the Joints of the hands and feet were obtained from a PsA cohort. For each analysis (symmetry, ray or row) for each outcome (Joint damage and activity) expected values for table cells under the null hypothesis that Joints progress independently to damage or activity were calculated based on a logistic regression model with patient level random effects for the probability of involvement developing between clinic visits. To determine the consistency of observed with expected values, goodness-of-fit tests were performed. Results Data from 704 patients were available. The 511 (552) patients with no hand (foot) damage at clinic entry were used for analyses of hand (foot) damage. When considering Joint damage, there was strong evidence against independence of Joint involvement based on evident symmetric patterns. There was little suggestion of ray patterns of Joint damage. There was considerable evidence for row pattern of involvement of Joints. When considering Joint activity, symmetric patterns were also evident but, unlike Joint damage, there was evidence of ray patterns, most notably in the hands. There was also evidence for row pattern involvement. Conclusion Patterns of Peripheral Joint involvement seen over time in PsA patients, demonstrate consistency with expected ray patterns of disease activity, especially in the hands, but there is also considerable evidence for symmetric and row patterns for both Joint damage and activity.

  • outcome measures in psoriatic arthritis
    The Journal of Rheumatology, 2005
    Co-Authors: Dafna D. Gladman, Philip S Helliwell, Philip J Mease, Gerald G Krueger, Desiree M F M Van Der Heidje, C Antoni, Arthur Kavanaugh, Peter Nash, Christopher T Ritchlin, Vibeke C Strand
    Abstract:

    Psoriatic arthritis (PsA), an inflammatory arthritis associated with psoriasis usually seronegative for rheumatoid factor, has emerged as a more common and severe disease than previously appreciated. The disease is multifaceted. Thus the assessment of PsA requires attention to Peripheral Joint involvement, axial disease, dactylitis, and enthesitis, as well as the skin manifestations. In addition, the assessment of patient reported features such as patient assessment of disease activity, pain, fatigue, quality of life, and the new concept of participation are important. The assessment of damage and the assessment of tissue histology are also important outcome measures. This article summarizes these features of PsA as well as current knowledge on the instruments available for the assessment of these domains.

Fatih Yildiz - One of the best experts on this subject based on the ideXlab platform.