To study whether the addition of dimethylsulfoxide (DMSO) to synovial fluid (SF) samples could be helpful to store frozen samples to improve the rates of detection and identification of crystals.
Cross-sectional study of samples of SF consecutively obtained. Three aliquots were generated: one for immediate observation by a senior observer, and 2 to be frozen, one with 10% DMSO (DMSO+) and one without DMSO (DMSO–). Each aliquot was randomly allocated and blinded for further observation when once the samples were unfrozen 3 months afterward. Variables included for analysis were total leucocyte count, detection of crystals, identification of present crystals as monosodium urate (MSU) or calcium pyrophosphate (CPP), number of fields to the first crystal observation, and number of crystals per field. The vitality of leucocytes was evaluated using a trypan blue stain. All samples were examined using ordinary light and polarized light with a red compensator, and unfrozen samples by both senior and junior observers.
In the 30 reference samples of SF studied, the mean leucocyte count was 13.1 × 109/L, and 18/30 samples showed crystals (8 MSU, 10 CPP). Once unfrozen, leucocyte counts were 58% lower in DMSO aliquots vs. 22% in DMSO+ aliquots, with vitality (> 50% cells) reduced from 100% in the reference sample to 76.6% in the DMSO+ aliquots to none in the DMSO− aliquots. Agreement in the detection of crystals was much better in DMSO+ aliquots than DMSO− (kappa 1.00 vs. 0.69 and 0.65 vs. 0.11 for the senior and junior observers respectively). Moreover, 4/5 false-negative crystal detection in DMSO− aliquots showed CPP in the reference simple, even though a high density of crystals was observed in the reference sample.
The addition of 10% DMSO to SF samples allows freezing and storage with a small loss of leucocyte counts and excellent agreement in the detection and identification of crystals. Cellular lysis may account for the false negative results in aliquots without DMSO, especially in the case of CPP, non-refringent crystals.
Gout often presents as acute arthritis but may also present with chronic joint inflammation. For the diagnosis of an acute gout attack with its typical symptoms, the differentiation towards a bacterial joint infection is critical and mandatory. The detection of intracellular uric acid crystals in the synovial fluid of affected joints is important for the initial diagnosis of gout. In the case of a chronic course with polyarticular joint involvement, the differentiation from other inflammatory rheumatic diseases such as rheumatoid arthritis (RA) can be challenging. The case presented here is of interest because the patient initially had characteristic clinical symptoms of tophaceous gout including a typical medical history—even though rheumatoid factor and anti-citrullinated protein antibodies (anti-CCP) were positive. The course of the disease and the critical evaluation of all findings also, and most interestingly, including histological results finally suggested a main diagnosis of RA.
[Names] => David Kiefer ... Juergen Braun [Doi] => 10.37349/emd.2023.00003 [Published] => February 24, 2023 [Viewed] => 884 [Downloaded] => 26 [Subject] => Case Report [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/emd.2023.00003 [Inline] => 1 [Type] => 1 [Issue] => 1 [Topic] => 0 [TitleAbbr] => Explor Musculoskeletal Dis. [Pages] => 2023;1:11–19 [Recommend] => 0 [Keywords] => Arthritis urica, rheumatoid arthritis, rheumatoid nodule, tophus, polyarthritis [DetailTitle] => [DetailUrl] => [Id] => 10073 [ris] => https://www.explorationpub.com/uploads/Article/A10073/cd9d5cbcd60b89a6ef60061aa596d84d.ris [bib] => https://www.explorationpub.com/uploads/Article/A10073/7a3d0a2a5a063abdfd9bc5d7befb5633.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Kiefer D, Erkenberg J, Braun J. Similarities and differences between gouty arthritis and rheumatoid arthritis—an interesting case with a short look into the literature. Explor Musculoskeletal Dis. 2023;1:11–9. https://doi.org/10.37349/emd.2023.00003 [Jindex] => 0 [CName] => DavidKiefer, [CEmail] => david.kiefer@elisabethgruppe.de, [Ris_Time] => 2023-02-23 05:16:00 [Bib_Time] => 2023-02-23 05:16:00 [KeysWordContens] => Similarities and differences between gouty arthritis and rheumatoid arthritis—an interesting case with a short look into the literature, Arthritis urica, rheumatoid arthritis, rheumatoid nodule, tophus, polyarthritis, Gout often presents as acute arthritis but may also present with chronic joint inflammation. For the diagnosis of an acute gout attack with its typical symptoms, the differentiation towards a bacterial joint infection is critical and mandatory. The detection of intracellular uric acid crystals in the synovial fluid of affected joints is important for the initial diagnosis of gout. In the case of a chronic course with polyarticular joint involvement, the differentiation from other inflammatory rheumatic diseases such as rheumatoid arthritis (RA) can be challenging. The case presented here is of interest because the patient initially had characteristic clinical symptoms of tophaceous gout including a typical medical history—even though rheumatoid factor and anti-citrullinated protein antibodies (anti-CCP) were positive. The course of the disease and the critical evaluation of all findings also, and most interestingly, including histological results finally suggested a main diagnosis of RA. ,David Kiefer ... Juergen Braun [PublishedText] => Published [IsEdit] => 0 [AccountId] => 38 ) [3] => Array ( [ArticleId] => 489 [Create_Time] => 2023-02-27 [zipUrl] => https://www.explorationpub.com/uploads/zip/202304/20230410083907.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A10074/10074.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A10074/10074.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A10074/10074_cover.png [JournalsId] => 9 [Title] => Towards a more ambitious uricemia target to improve joint and cardiovascular outcomes in gout [Abstract] => Gout is the most common inflammatory arthritis and a global health problem. In addition to joint involvement, urate crystals induce chronic inflammation, leading to increased cardiovascular risk in gout. Thus, cardiovascular disease is the leading cause of death in gout and numerous studies have revealed an increase in cardiovascular-related mortality in these patients. However, despite the efficacy of urate-lowering therapies, such as allopurinol and febuxostat, suboptimal management of gout and poor adherence continue to make it difficult to achieve better outcomes. Treat-to-target strategy may help change this, as in other diseases such as rheumatoid arthritis. Nevertheless, even with a well-defined clinical target (absence of flares and tophi disappearance), the numerical target [serum uric acid (SUA) < 5 mg/dL or < 6 mg/dL] still varies depending on current guidelines and consensus documents. Recently, several trials [Long-Term Cardiovascular Safety of Febuxostat Compared with Allopurinol in Patients with Gout (FAST), REasons for Geographic And Racial Differences in Stroke (REGARDS)] have shown better cardiovascular outcomes in those patients who achieve SUA levels < 5 mg/dL. Likewise, some observational studies, mostly based on imaging tests such as ultrasound and dual-energy computed tomography, have found better results in the magnitude and speed of reduction of urate joint deposition when SUA < 5 mg/dL is achieved. Based on an analysis of the available evidence, SUA < 5 mg/dL is postulated as a more ambitious target within the treat-to-target approach for the management of gout to achieve better joint and cardiovascular outcomes in patients with cardiovascular risk or severe disease. [AbstractComplete] =>Gout is the most common inflammatory arthritis and a global health problem. In addition to joint involvement, urate crystals induce chronic inflammation, leading to increased cardiovascular risk in gout. Thus, cardiovascular disease is the leading cause of death in gout and numerous studies have revealed an increase in cardiovascular-related mortality in these patients. However, despite the efficacy of urate-lowering therapies, such as allopurinol and febuxostat, suboptimal management of gout and poor adherence continue to make it difficult to achieve better outcomes. Treat-to-target strategy may help change this, as in other diseases such as rheumatoid arthritis. Nevertheless, even with a well-defined clinical target (absence of flares and tophi disappearance), the numerical target [serum uric acid (SUA) < 5 mg/dL or < 6 mg/dL] still varies depending on current guidelines and consensus documents. Recently, several trials [Long-Term Cardiovascular Safety of Febuxostat Compared with Allopurinol in Patients with Gout (FAST), REasons for Geographic And Racial Differences in Stroke (REGARDS)] have shown better cardiovascular outcomes in those patients who achieve SUA levels < 5 mg/dL. Likewise, some observational studies, mostly based on imaging tests such as ultrasound and dual-energy computed tomography, have found better results in the magnitude and speed of reduction of urate joint deposition when SUA < 5 mg/dL is achieved. Based on an analysis of the available evidence, SUA < 5 mg/dL is postulated as a more ambitious target within the treat-to-target approach for the management of gout to achieve better joint and cardiovascular outcomes in patients with cardiovascular risk or severe disease.
[Names] => Enrique Calvo-Aranda, Fernando Perez-Ruiz [Doi] => 10.37349/emd.2023.00004 [Published] => February 27, 2023 [Viewed] => 379 [Downloaded] => 17 [Subject] => Perspective [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/emd.2023.00004 [Inline] => 1 [Type] => 1 [Issue] => 1 [Topic] => 0 [TitleAbbr] => Explor Musculoskeletal Dis. [Pages] => 2023;1:20–25 [Recommend] => 0 [Keywords] => Gout, uric acid, urate, crystals, treat-to-target, cardiovascular, arthritis [DetailTitle] => [DetailUrl] => [Id] => 10074 [ris] => https://www.explorationpub.com/uploads/Article/A10074/bf5043206b0d4e616a9ba41c659a6cbf.ris [bib] => https://www.explorationpub.com/uploads/Article/A10074/6040f4350b1655af545c11b29ad23bf6.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Calvo-Aranda E, Perez-Ruiz F. Towards a more ambitious uricemia target to improve joint and cardiovascular outcomes in gout. Explor Musculoskeletal Dis. 2023;1:20–5. https://doi.org/10.37349/emd.2023.00004 [Jindex] => 0 [CName] => EnriqueCalvo-Aranda, [CEmail] => ecalvoa@hotmail.com, [Ris_Time] => 2023-02-27 03:36:03 [Bib_Time] => 2023-02-27 03:36:03 [KeysWordContens] => Towards a more ambitious uricemia target to improve joint and cardiovascular outcomes in gout, Gout, uric acid, urate, crystals, treat-to-target, cardiovascular, arthritis, Gout is the most common inflammatory arthritis and a global health problem. In addition to joint involvement, urate crystals induce chronic inflammation, leading to increased cardiovascular risk in gout. Thus, cardiovascular disease is the leading cause of death in gout and numerous studies have revealed an increase in cardiovascular-related mortality in these patients. However, despite the efficacy of urate-lowering therapies, such as allopurinol and febuxostat, suboptimal management of gout and poor adherence continue to make it difficult to achieve better outcomes. Treat-to-target strategy may help change this, as in other diseases such as rheumatoid arthritis. Nevertheless, even with a well-defined clinical target (absence of flares and tophi disappearance), the numerical target [serum uric acid (SUA) < 5 mg/dL or < 6 mg/dL] still varies depending on current guidelines and consensus documents. Recently, several trials [Long-Term Cardiovascular Safety of Febuxostat Compared with Allopurinol in Patients with Gout (FAST), REasons for Geographic And Racial Differences in Stroke (REGARDS)] have shown better cardiovascular outcomes in those patients who achieve SUA levels < 5 mg/dL. Likewise, some observational studies, mostly based on imaging tests such as ultrasound and dual-energy computed tomography, have found better results in the magnitude and speed of reduction of urate joint deposition when SUA < 5 mg/dL is achieved. Based on an analysis of the available evidence, SUA < 5 mg/dL is postulated as a more ambitious target within the treat-to-target approach for the management of gout to achieve better joint and cardiovascular outcomes in patients with cardiovascular risk or severe disease. ,Enrique Calvo-Aranda, Fernando Perez-Ruiz [PublishedText] => Published [IsEdit] => 0 [AccountId] => 45 ) [4] => Array ( [ArticleId] => 502 [Create_Time] => 2023-02-27 [zipUrl] => https://www.explorationpub.com/uploads/zip/202304/20230410052117.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A10075/10075.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A10075/10075.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A10075/10075_cover.png [JournalsId] => 9 [Title] => Infection after reconstruction of the anterior cruciate ligament [Abstract] => Aim: Postoperative infection after the anterior cruciate ligament reconstruction (ACLR) can destroy the knee cartilage, necessitate graft removal, and cause arthrofibrosis, instability, limitatio [AbstractComplete] =>Postoperative infection after the anterior cruciate ligament reconstruction (ACLR) can destroy the knee cartilage, necessitate graft removal, and cause arthrofibrosis, instability, limitation of motion, chronic pain, and disability. While being an uncommon complication, the actual number of infected patients might be rather high due to a large number of operations performed. As the operation is usually indicated in young, healthy, and active individuals, failure to achieve the expected improvement, due to complications, is perceived as much graver. The purpose of this study was to analyze the infecting organisms in patients that underwent ACLR at our institution, a tertiary care center, for precise microbiological diagnosis and bacterial susceptibility and resistance to antibiotics.
The rate of infection, the infecting organisms, the antibiotic susceptibility, and the resistance were analyzed in 1,395 patients that underwent ACLR using descriptive statistics.
Three patients (0.93%) were diagnosed with a postoperative infection; all underwent arthroscopic debridement and lavage. All infections were caused by Staphylococci [3 Staphylococcus aureus (S. aureus, all oxacillin sensitive), 6 coagulase-negative Staphylococci (3 oxacillin resistant)]. No gram-negative, gastrointestinal tract bacteria, fungal or polymicrobial infections were detected. Thirty eight and a half percent of patients had returned to previous or near previous levels of activity.
Preventing infection by controlling risk factors, prophylactic antibiotics, proper surgical preparation, and surgical technique is mandatory. When infection does occur, rapid recognition and prompt treatment are necessary to avoid irreversible damage to the knee joint and the need for graft removal. Despite appropriate treatment, the functional outcomes were inferior to expected after an uncomplicated ACLR.
Congenital fused/blocked vertebrae are an incidental finding in most cases. It remains asymptomatic unless there is a traumatic event or there is an increased biomechanical load which may be attributed to a task that is not typically performed by the individual. Symptomatic cases can present with several musculoskeletal symptoms including neck pain. Physiotherapy management strategies may help patients recover from the mechanical strains on the cervical neuromuscular structures. The present case is of a 21-year-old male engineering student who was referred for physiotherapy, he presented with complaints of neck pain (non-radiating in nature) for a week. The intensity of the pain had been intermittently increasing/decreasing for about a year and there were about 2–3 episodes in a month for approximately one year. He presented with an X-ray that showed C3–C4 cervical vertebrae synostosis (block vertebrae). The patient was managed using pain education and exercises along with ergonomic advice. Patient-reported pain decreased significantly from the initial visit and he was able to sit for a longer duration and had a considerable improvement in function.
[Names] => Sarah Quais, Ammar Suhail [Doi] => 10.37349/emd.2023.00006 [Published] => March 27, 2023 [Viewed] => 755 [Downloaded] => 25 [Subject] => Case Report [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/emd.2023.00006 [Inline] => 1 [Type] => 1 [Issue] => 2 [Topic] => 0 [TitleAbbr] => Explor Musculoskeletal Dis. [Pages] => 2023;1:31–36 [Recommend] => 0 [Keywords] => Neck pain, block vertebra, exercise therapy, hypermobility [DetailTitle] => [DetailUrl] => [Id] => 10076 [ris] => https://www.explorationpub.com/uploads/Article/A10076/e548e953abb1e6c42b163ed009bc525f.ris [bib] => https://www.explorationpub.com/uploads/Article/A10076/20f6810b68e04d8079dda2830f34ab2f.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Quais S, Suhail A. Physiotherapy management of a patient with neck pain having block vertebra: a case report. Explor Musculoskeletal Dis. 2023;1:31–6. https://doi.org/10.37349/emd.2023.00006 [Jindex] => 0 [CName] => AmmarSuhail, [CEmail] => asuhail38@gmail.com, [Ris_Time] => 2023-03-17 07:43:09 [Bib_Time] => 2023-03-17 07:43:09 [KeysWordContens] => Physiotherapy management of a patient with neck pain having block vertebra: a case report, Neck pain, block vertebra, exercise therapy, hypermobility, Congenital fused/blocked vertebrae are an incidental finding in most cases. It remains asymptomatic unless there is a traumatic event or there is an increased biomechanical load which may be attributed to a task that is not typically performed by the individual. Symptomatic cases can present with several musculoskeletal symptoms including neck pain. Physiotherapy management strategies may help patients recover from the mechanical strains on the cervical neuromuscular structures. The present case is of a 21-year-old male engineering student who was referred for physiotherapy, he presented with complaints of neck pain (non-radiating in nature) for a week. The intensity of the pain had been intermittently increasing/decreasing for about a year and there were about 2–3 episodes in a month for approximately one year. He presented with an X-ray that showed C3–C4 cervical vertebrae synostosis (block vertebrae). The patient was managed using pain education and exercises along with ergonomic advice. Patient-reported pain decreased significantly from the initial visit and he was able to sit for a longer duration and had a considerable improvement in function. ,Sarah Quais, Ammar Suhail [PublishedText] => Published [IsEdit] => 0 [AccountId] => 55 ) [6] => Array ( [ArticleId] => 524 [Create_Time] => 2023-04-12 [zipUrl] => https://www.explorationpub.com/uploads/zip/202304/20230412071226.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A10077/10077.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A10077/10077.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A10077/10077_cover.png [JournalsId] => 9 [Title] => Quality of care, referral, and early diagnosis of axial spondyloarthritis [Abstract] => [AbstractComplete] => [Names] => Jürgen Braun ... Xenofon Baraliakos [Doi] => 10.37349/emd.2023.00007 [Published] => April 12, 2023 [Viewed] => 363 [Downloaded] => 28 [Subject] => Editorial [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/emd.2023.00007 [Inline] => 1 [Type] => 1 [Issue] => 2 [Topic] => 0 [TitleAbbr] => Explor Musculoskeletal Dis. [Pages] => 2023;1:37–42 [Recommend] => 1 [Keywords] => [DetailTitle] => [DetailUrl] => [Id] => 10077 [ris] => https://www.explorationpub.com/uploads/Article/A10077/74e9025ce43d5b0992217c5460d64c4f.ris [bib] => https://www.explorationpub.com/uploads/Article/A10077/7739ce0c1f3b2a43a363c9f717b3cc31.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Braun J, Kiltz U, Baraliakos X. Quality of care, referral, and early diagnosis of axial spondyloarthritis. Explor Musculoskeletal Dis. 2023;1:37–42. https://doi.org/10.37349/emd.2023.00007 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-04-09 08:08:15 [Bib_Time] => 2023-04-09 08:08:15 [KeysWordContens] => Quality of care, referral, and early diagnosis of axial spondyloarthritis,,,Jürgen Braun ... Xenofon Baraliakos [PublishedText] => Published [IsEdit] => 0 [AccountId] => 22 ) [7] => Array ( [ArticleId] => 573 [Create_Time] => 2023-04-27 [zipUrl] => https://www.explorationpub.com/uploads/zip/202306/20230615010625.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A10078/10078.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A10078/10078.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A10078/10078_cover.png [JournalsId] => 9 [Title] => Is there a place for magnetic resonance imaging in diffuse idiopathic skeletal hyperostosis? [Abstract] => Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by the new bone formation and enthesopathies of the axial and peripheral skeleton. The diagnosis of DISH current [AbstractComplete] =>Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by the new bone formation and enthesopathies of the axial and peripheral skeleton. The diagnosis of DISH currently relies upon the end-stage radiographic criteria of Resnick and Niwayama, in which bridging osteophytes are present over at least four thoracic vertebras. The pathogenesis of DISH is not well understood, and it is currently considered a non-inflammatory condition with an underlying metabolic derangement. However, an inflammatory component was suggested due to the similarities between DISH and spondyloarthritis (SpA) in spinal and peripheral entheseal new bone formation. Magnetic resonance imaging (MRI) is the imaging modality of choice in the diagnostic work-up and follow-up of patients with SpA, as well as in understanding its pathogenesis. The aims of the current review were to evaluate the current and future role of MRI in imaging DISH.
[Names] => Iris Eshed [Doi] => 10.37349/emd.2023.00008 [Published] => April 27, 2023 [Viewed] => 368 [Downloaded] => 25 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/emd.2023.00008 [Inline] => 1 [Type] => 1 [Issue] => 2 [Topic] => 119 [TitleAbbr] => Explor Musculoskeletal Dis. [Pages] => 2023;1:43–53 [Recommend] => 0 [Keywords] => Diffuse idiopathic skeletal hyperostosis, magnetic resonance imaging, spine, sacroiliac joints, entheses, osteophytes [DetailTitle] => Diffuse Idiopathic Skeletal Hyperostosis- A common but neglected disease [DetailUrl] => https://www.explorationpub.com/Journals/emd/Special_Issues/119 [Id] => 10078 [ris] => https://www.explorationpub.com/uploads/Article/A10078/89ab4d0d940ebbd0be115d350bc3a18b.ris [bib] => https://www.explorationpub.com/uploads/Article/A10078/9ea6bc399488f2f6bd082af9dd96de9f.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Eshed I. Is there a place for magnetic resonance imaging in diffuse idiopathic skeletal hyperostosis? Explor Musculoskeletal Dis. 2023;1:43–53. https://doi.org/10.37349/emd.2023.00008 [Jindex] => 0 [CName] => IrisEshed, [CEmail] => iriseshed@gmail.com, [Ris_Time] => 2023-04-26 08:32:46 [Bib_Time] => 2023-04-26 08:32:46 [KeysWordContens] => Is there a place for magnetic resonance imaging in diffuse idiopathic skeletal hyperostosis?, Diffuse idiopathic skeletal hyperostosis, magnetic resonance imaging, spine, sacroiliac joints, entheses, osteophytes, Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by the new bone formation and enthesopathies of the axial and peripheral skeleton. The diagnosis of DISH currently relies upon the end-stage radiographic criteria of Resnick and Niwayama, in which bridging osteophytes are present over at least four thoracic vertebras. The pathogenesis of DISH is not well understood, and it is currently considered a non-inflammatory condition with an underlying metabolic derangement. However, an inflammatory component was suggested due to the similarities between DISH and spondyloarthritis (SpA) in spinal and peripheral entheseal new bone formation. Magnetic resonance imaging (MRI) is the imaging modality of choice in the diagnostic work-up and follow-up of patients with SpA, as well as in understanding its pathogenesis. The aims of the current review were to evaluate the current and future role of MRI in imaging DISH. ,Iris Eshed [PublishedText] => Published [IsEdit] => 0 [AccountId] => 57 ) [8] => Array ( [ArticleId] => 627 [Create_Time] => 2023-06-29 [zipUrl] => https://www.explorationpub.com/uploads/zip/202306/20230629072326.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A10079/10079.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A10079/10079.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A10079/10079_cover.png [JournalsId] => 9 [Title] => Quantitative magnetic resonance spectroscopy and imaging analysis of the lipid content in the psoas major and its association with intervertebral disc degeneration: a cross-sectional study [Abstract] => Aim: It is shown that the diminished function of the psoas major is mainly associated with increased lipid content; nonetheless, whether the fat content of the psoas major is associated with inte [AbstractComplete] =>It is shown that the diminished function of the psoas major is mainly associated with increased lipid content; nonetheless, whether the fat content of the psoas major is associated with intervertebral disc degeneration (IVDD) is still under study. It is hypothesized that IVDD is correlated with the lipid content of the psoas major and that IVDD can be comprehensively investigated using quantitative magnetic resonance imaging (MRI). Consequently, this study aimed to analyse the association between the psoas major extramyocellular lipid (EMCL) and intramyocellular lipid (IMCL) content and disc degeneration quantified using MRI T2 mapping in patients with chronic low back pain (CLBP).
In this study, 20 men and 23 women (mean age, 63.1 years ± 2.6 years) underwent magnetic resonance spectroscopy (MRS). The psoas major IMCL and EMCL content of patients was analysed. T2 values of the anterior annulus fibrosus (AF), nucleus pulposus (NP), and posterior AF were evaluated using MRI T2 mapping. Multiple linear regression analysis was used to determine the possible correlations of the psoas major EMCL and IMCL content with the T2 values of the anterior AF, NP, and posterior AF.
The EMCL content and T2 values of the anterior AF were significantly and negatively correlated [standardised partial regression coefficient (β) = −0.60, P < 0.01]. There were no significant correlations between the EMCL content and T2 values of the NP (β = −0.16, P = 0.30) or posterior AF (β = −0.14, P = 0.49) or between the IMCL content and T2 values of the anterior AF (β = −0.04, P = 0.82), NP (β = 0.05, P = 0.73), or posterior AF (β = −0.11, P = 0.58).
The EMCL content and T2 values of the anterior AF were correlated. Conversely, the IMCL content and T2 values were not correlated.
To identify constitutional morphological features at the knee that associate with knee osteoarthritis (OA, KOA).
This was a case-control study using data from the Genetics of Osteoarthritis and Lifestyle (GOAL) study. Radiographic measurements at the knee were undertaken by a single trained observer. Measurement of 12 characteristics was undertaken in 815 controls with asymptomatic structurally normal knees to examine right-left symmetry and variation with gender and age. Measurements were then compared to “cases” (315 asymptomatic and structurally unaffected knees of people with radiographic and symptomatic OA in the contralateral knee) on the assumption that the morphology of the unaffected knee represented the morphology of the contralateral knee prior to the development of OA. Right-left symmetry of morphological measures in controls was examined using paired t test and minimal detectable change (MDC). Linear regression was used to examine the association between measurements and demographic characteristics. Association of morphological features and unilateral KOA [defined as OA in either patellofemoral (PF) or tibiofemoral (TF) joints], PFOA and TFOA were determined using binary logistic regression and odds ratio (OR) and 95% confidence interval (CI) calculated. Cumulative risk of measurements in determining OA was examined using receiver operating characteristic (ROC) curves.
Narrow sulcus and condylar angles, increasing distal femoral, proximal tibial tilt, and increasing varus alignment associated with KOA. ROC curves including all significant morphological features and age, gender, height, and weight predicted knee, PF joint (PFJ), and TF joint (TFJ) OA with area under the curve (AUC) of 0.91, 0.89, and 0.90 respectively. On the contrary, a model only containing age, gender, height, and weight predicted knee, PFJ, and TFJ OA with AUC of 0.59, 0.67, and 0.59 respectively.
Five morphological features associated independently with KOA were identified. Together they explain a large proportion of risk for OA.
Systemic vasculitis is a heterogeneous group of disorders characterized by inflammation and necrosis in the vessel wall. Patients usually present a quite broad spectrum of manifestations which vary in terms of vessels’ size affected, organs involvement, and the extent of inflammatory process as well as an immunological diversity, including autoantibodies profile. Though, the diagnosis is based on clinical features, tissue biopsy, imaging investigations, and serologic tests. The main autoantibodies, important not only in the diagnosis but also in monitoring and prognosis of systemic vasculitides, are anti-neutrophil cytoplasmic antibodies (ANCA), anti-glomerular basement membrane antibodies (anti-GBM), anti-complement component C1q antibodies (anti-C1q), and cryoglobulins. Although other autoantibodies have been analyzed, their clinical utility still needs further investigation. The current work aimed to review the clinical associations of main autoantibodies in systemic vasculitis.
[Names] => Katarzyna Fischer, Marek Brzosko [Doi] => 10.37349/emd.2023.00012 [Published] => July 17, 2023 [Viewed] => 170 [Downloaded] => 19 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/emd.2023.00012 [Inline] => 1 [Type] => 1 [Issue] => 4 [Topic] => 0 [TitleAbbr] => Explor Musculoskeletal Dis. [Pages] => 2023;1:77–83 [Recommend] => 0 [Keywords] => Systemic vasculitis, anti-neutrophil cytoplasmic antibodies, anti-glomerular basement membrane antibodies, anti-complement component C1q antibodies, cryoglobulins [DetailTitle] => [DetailUrl] => [Id] => 100712 [ris] => https://www.explorationpub.com/uploads/Article/A100712/2fb7f0f133551dd9a2988fab819bc62d.ris [bib] => https://www.explorationpub.com/uploads/Article/A100712/8dab142a93fe3a61df791743c6c8ab29.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Fischer K, Brzosko M. Significance of autoantibodies in diagnostics of systemic vasculitis. Explor Musculoskeletal Dis. 2023;1:77–83. https://doi.org/10.37349/emd.2023.00012 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-07-17 06:02:19 [Bib_Time] => 2023-07-17 06:02:19 [KeysWordContens] => Significance of autoantibodies in diagnostics of systemic vasculitis, Systemic vasculitis, anti-neutrophil cytoplasmic antibodies, anti-glomerular basement membrane antibodies, anti-complement component C1q antibodies, cryoglobulins, Systemic vasculitis is a heterogeneous group of disorders characterized by inflammation and necrosis in the vessel wall. Patients usually present a quite broad spectrum of manifestations which vary in terms of vessels’ size affected, organs involvement, and the extent of inflammatory process as well as an immunological diversity, including autoantibodies profile. Though, the diagnosis is based on clinical features, tissue biopsy, imaging investigations, and serologic tests. The main autoantibodies, important not only in the diagnosis but also in monitoring and prognosis of systemic vasculitides, are anti-neutrophil cytoplasmic antibodies (ANCA), anti-glomerular basement membrane antibodies (anti-GBM), anti-complement component C1q antibodies (anti-C1q), and cryoglobulins. Although other autoantibodies have been analyzed, their clinical utility still needs further investigation. The current work aimed to review the clinical associations of main autoantibodies in systemic vasculitis. ,Katarzyna Fischer, Marek Brzosko [PublishedText] => Published [IsEdit] => 0 [AccountId] => 55 ) [12] => Array ( [ArticleId] => 722 [Create_Time] => 2023-08-30 [zipUrl] => https://www.explorationpub.com/uploads/zip/202308/20230829083045.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A100713/100713.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A100713/100713.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A100713/100713_cover.png [JournalsId] => 9 [Title] => Perioperative management, operative techniques, and pitfalls in the surgical treatment of patients with diffuse idiopathic skeletal hyperostosis: a narrative review [Abstract] => Diffuse idiopathic skeletal hyperostosis (DISH) can lead to dysphagia, airway obstruction, and unstable vertebral fractures. Surgery can be performed to relieve cervical compression or stabilize fra [AbstractComplete] =>Diffuse idiopathic skeletal hyperostosis (DISH) can lead to dysphagia, airway obstruction, and unstable vertebral fractures. Surgery can be performed to relieve cervical compression or stabilize fractures of the spinal column, with or without decompression of spinal cord injuries. In this review, the peri-operative surgical techniques in cases with DISH are discussed, as well as the pre-operative and post-operative pearls and pitfalls. It is essential for spine surgeons, including orthopedic surgeons and neurosurgeons, to be aware of the considerations, anticipations, and approaches for the management of dysphagia, airway obstruction, and fractures in DISH patients in order to improve patient outcomes for this specific at-risk patient population.
[Names] => Netanja I. Harlianto ... Jorrit-Jan Verlaan [Doi] => 10.37349/emd.2023.00013 [Published] => August 29, 2023 [Viewed] => 142 [Downloaded] => 11 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/emd.2023.00013 [Inline] => 1 [Type] => 1 [Issue] => 4 [Topic] => 119 [TitleAbbr] => Explor Musculoskeletal Dis. [Pages] => 2023;1:84–96 [Recommend] => 0 [Keywords] => Diffuse idiopathic skeletal hyperostosis, surgical approach, surgical technique, surgical management, surgical complications, vertebral fracture, dysphagia [DetailTitle] => Diffuse Idiopathic Skeletal Hyperostosis- A common but neglected disease [DetailUrl] => https://www.explorationpub.com/Journals/emd/Special_Issues/119 [Id] => 100713 [ris] => https://www.explorationpub.com/uploads/Article/A100713/13fd5a643e92e74c56304de846844f0a.ris [bib] => https://www.explorationpub.com/uploads/Article/A100713/f28b37966bb50d23061003a209e98772.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Harlianto NI, Kuperus JS, Verlaan JJ. Perioperative management, operative techniques, and pitfalls in the surgical treatment of patients with diffuse idiopathic skeletal hyperostosis: a narrative review. Explor Musculoskeletal Dis. 2023;1:84–96. https://doi.org/10.37349/emd.2023.00013 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-08-26 05:11:40 [Bib_Time] => 2023-08-26 05:11:40 [KeysWordContens] => Perioperative management, operative techniques, and pitfalls in the surgical treatment of patients with diffuse idiopathic skeletal hyperostosis: a narrative review, Diffuse idiopathic skeletal hyperostosis, surgical approach, surgical technique, surgical management, surgical complications, vertebral fracture, dysphagia, Diffuse idiopathic skeletal hyperostosis (DISH) can lead to dysphagia, airway obstruction, and unstable vertebral fractures. Surgery can be performed to relieve cervical compression or stabilize fractures of the spinal column, with or without decompression of spinal cord injuries. In this review, the peri-operative surgical techniques in cases with DISH are discussed, as well as the pre-operative and post-operative pearls and pitfalls. It is essential for spine surgeons, including orthopedic surgeons and neurosurgeons, to be aware of the considerations, anticipations, and approaches for the management of dysphagia, airway obstruction, and fractures in DISH patients in order to improve patient outcomes for this specific at-risk patient population. ,Netanja I. Harlianto ... Jorrit-Jan Verlaan [PublishedText] => Published [IsEdit] => 0 [AccountId] => 76 ) [13] => Array ( [ArticleId] => 730 [Create_Time] => 2023-08-30 [zipUrl] => https://www.explorationpub.com/uploads/zip/202308/20230831011903.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A100714/100714.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A100714/100714.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A100714/100714_cover.png [JournalsId] => 9 [Title] => Real-life results of urate-driven pharmacotherapy with three urate lowering drugs in gout: allopurinol, febuxostat and benzbromarone [Abstract] => Aim: This study aims to assess outcomes of gout patients from the treat to target (T2T) perspective at 6 months and 12 months while using urate lowering therapy (ULT): allopurinol, febuxostat, an [AbstractComplete] =>This study aims to assess outcomes of gout patients from the treat to target (T2T) perspective at 6 months and 12 months while using urate lowering therapy (ULT): allopurinol, febuxostat, and/or benzbromarone.
All gout patients visiting the Rheumatology department between 2015 to 2021 were identified from the digital hospital system. The diagnosis of gout was based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2015 classification criteria. Patient outcomes were predefined intention to treat (ITT) categories: category 1: patients with serum uric acid (sUA) ≤ 0.360 mmol/L (ACR target for gout); category 2: patients with sUA ≤ 0.300 mmol/L (ACR/EULAR target for severe gout); category 3: patients with sUA > 0.360 (failure to meet ACR target).
Gout diagnoses were present in 1,186 patients: 986 (83.1%) males and 200 (16.9%) females. A follow-visit at 6 months was present in 76.9% (n = 856) out of 1,113 patients reaching sUA < 0.36 mmol/L, but 257 (23%) failed to reach the 0.36 mmol/L target. At 12 months, a follow-up visit was available in 792 (71.1%) patients, and from these, 710 (90%) had reached sUA < 0.36 mmol/L target. The use of benzbromarone was a strong predictor of reaching the sUA < 0.30 mmol/L target: odds ratio (OR) 3.2, 95% confidence interval (CI) (1.735, 6.017) at 6 months. Diabetic patients had the highest proportion of not reaching the target: 18%. Male patients needed higher dosages of allopurinol to reach the sUA target at 6 months compared to female patients.
This is a large study on a T2T approach based in a real-life clinical setting. Only 42% reached the sUA target at 6 months with allopurinol 300 mg quaque die (QD) monotherapy. About 77% of gout patients reach the predefined sUA target of 0.36 mmol/L at 6 months with the availability of three ULTs. There is still a significant unmet need in gout as many patients failed to achieve predefined sUA targets.
Hyperuricemia is known to be a necessary and causal condition for gout, but much more prevalent than gout. Medicine has standardized treatments for gout, but has no such determination for asymptomatic hyperuricemia. Nevertheless, people with hyperuricemia, gouty or not, too often continue to be at risk for shortened lifespans from life-threatening comorbidities, all of which are known to be consequences of obstructive sleep apnea (OSA), which is shown herein to cause most hyperuricemia. This review also presents the wide variety of OSA consequences, many of which are irreversible and life-threatening, as the rationale for treating all hyperuricemia (gouty and asymptomatic) by diagnostic testing and effective treatment for OSA as soon as hyperuricemia is detected. It advocates frequent ultrasonic screening for aggregated urate crystals. Multiple epidemiological studies have found OSA to be significantly more prevalent in those people with gout diagnosed with OSA than it is in those never diagnosed with it. A clinical study shows an even higher prevalence of OSA in people with gout. The pathophysiology of hypoxia from OSA explains how it would lead to both the overproduction and the underexcretion of uric acid, leading to hyperuricemia and the precipitation of monosodium urate crystals which cause a gout flare. Resolving OSA has been shown to prevent or even reverse life-threatening diseases that are recognized comorbidities of hyperuricemia and gout, and can prevent further gout flares. In order to extend the length and quality of life of people with gout or hyperuricemia, when either first manifests a patient sleep study is recommended, followed by effective OSA treatment as warranted.
[Names] => Burton Abrams [Doi] => 10.37349/emd.2023.00015 [Published] => August 31, 2023 [Viewed] => 194 [Downloaded] => 19 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/emd.2023.00015 [Inline] => 1 [Type] => 1 [Issue] => 4 [Topic] => 189 [TitleAbbr] => Explor Musculoskeletal Dis. [Pages] => 2023;1:106–120 [Recommend] => 0 [Keywords] => Gout, hyperuricemia, sleep apnea, hypoxia, urate, metabolic comorbidities, ultrasonic [DetailTitle] => Hyperuricemia current state and prospects [DetailUrl] => https://www.explorationpub.com/Journals/emd/Special_Issues/189 [Id] => 100715 [ris] => https://www.explorationpub.com/uploads/Article/A100715/717e108a8f5170f8c9d45c7fcc0b5e8b.ris [bib] => https://www.explorationpub.com/uploads/Article/A100715/0783a178ad037c5c2fbf7adb36e5ff9b.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Abrams B. Premature mortality with gout and hyperuricemia may be reduced by early resolution of comorbid obstructive sleep apnea. Explor Musculoskeletal Dis. 2023;1:106–20. https://doi.org/10.37349/emd.2023.00015 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-08-31 07:59:47 [Bib_Time] => 2023-08-31 07:59:47 [KeysWordContens] => Premature mortality with gout and hyperuricemia may be reduced by early resolution of comorbid obstructive sleep apnea, Gout, hyperuricemia, sleep apnea, hypoxia, urate, metabolic comorbidities, ultrasonic, Hyperuricemia is known to be a necessary and causal condition for gout, but much more prevalent than gout. Medicine has standardized treatments for gout, but has no such determination for asymptomatic hyperuricemia. Nevertheless, people with hyperuricemia, gouty or not, too often continue to be at risk for shortened lifespans from life-threatening comorbidities, all of which are known to be consequences of obstructive sleep apnea (OSA), which is shown herein to cause most hyperuricemia. This review also presents the wide variety of OSA consequences, many of which are irreversible and life-threatening, as the rationale for treating all hyperuricemia (gouty and asymptomatic) by diagnostic testing and effective treatment for OSA as soon as hyperuricemia is detected. It advocates frequent ultrasonic screening for aggregated urate crystals. Multiple epidemiological studies have found OSA to be significantly more prevalent in those people with gout diagnosed with OSA than it is in those never diagnosed with it. A clinical study shows an even higher prevalence of OSA in people with gout. The pathophysiology of hypoxia from OSA explains how it would lead to both the overproduction and the underexcretion of uric acid, leading to hyperuricemia and the precipitation of monosodium urate crystals which cause a gout flare. Resolving OSA has been shown to prevent or even reverse life-threatening diseases that are recognized comorbidities of hyperuricemia and gout, and can prevent further gout flares. In order to extend the length and quality of life of people with gout or hyperuricemia, when either first manifests a patient sleep study is recommended, followed by effective OSA treatment as warranted. ,Burton Abrams [PublishedText] => Published [IsEdit] => 0 [AccountId] => 57 ) [15] => Array ( [ArticleId] => 824 [Create_Time] => 2023-09-28 [zipUrl] => https://www.explorationpub.com/uploads/zip/202309/20230928010314.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A100716/100716.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A100716/100716.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A100716/100716_cover.png [JournalsId] => 9 [Title] => Prevalence and factors associated to diffuse idiopathic skeletal hyperostosis in gout [Abstract] => Aim: To evaluate the prevalence, associated factors, and the impact of diffuse idiopathic skeletal hyperostosis (DISH) in patients with gout. Methods: Patients with gout entering into an in [AbstractComplete] =>To evaluate the prevalence, associated factors, and the impact of diffuse idiopathic skeletal hyperostosis (DISH) in patients with gout.
Patients with gout entering into an inception cohort were evaluated for either spinal or peripheral hyperostosis from January 2022 to April 2023. Age, gender, along with comorbid conditions associated to gout and DISH were analyzed, including the presence either axial or peripheral hyperostosis and associated calcium pyrophosphate arthritis (CPPA).
The prevalence of DISH was 25.6% (31/121) patients, neat peripheral joint hyperostosis affecting 51.6% (16/31). CPPA was also present in 11.6% (14/121) patients. Only older age and male gender were independently associated to the presence of DISH. The presence of hyperostosis in peripheral joints was not associated to a worse initial evaluation of the severity of gout.
The presence of DISH in patients with gout seems to be related mostly to aging. Conditions apparently associated to DISH in gout patients seem therefore to be related to aging.