Scandinavian Journal of Rheumatology最新文献

Objective: Ultrasonography has been proposed as the initial diagnostic modality in suspected giant cell arteritis. Proposed quality standards advocate for a certified sonographer. Currently, there are no formal training programmes, and single educational events do not suffice as certification. We developed a preceptorship programme for diagnostic ultrasonography. Here, we describe its contents and test its efficacy.

Method: The programme comprises three stages. The preclinical stage includes machine setting and surface anatomy. Second stage includes supervised assessment, passed via a directly observed procedure form. In the final validation stage, the trainee and trainer perform an ultrasonography examination in succession, with a comparison of the results. For this programme, a scan included all three segments of the superficial temporal artery and all three parts of the axillary arteries. Comparison of the intima-media thickness (IMT) and categorical judgements for the halo sign and final diagnosis were made.

Results: Six trainees have been through this programme so far. A median of 16 ultrasonography examinations was required to reach the validation stage. The mean ± SD IMT in 360 segments, as measured by the trainee and trainer, was 0.45 ± 0.34 and 0.46 ± 0.35, respectively (p = 0.26). The agreement between trainee and trainer for the presence or absence of halo was excellent in 403 segments (κ = 0.91, 95% confidence interval 0.86, 0.96). There was 100% agreement on the final diagnosis.

Conclusion: The integration of technical knowledge with practical skills results in a robust training programme, validating trainees to continue scanning independently.

Objective: Complete response to colchicine is reported in 60-65% of patients with familial Mediterranean fever (FMF), partial response in 30-35%, and poor response in 5-10% of patients. The objective of our study was to revisit colchicine response rates for the common FMF gene (MEFV) genotypes in view of newly available treatments.

Method: Data were retrieved from medical files of 106 consecutive FMF patients, who were divided into four groups: patients with complete response, having had no attacks in the past year; near complete, with one or two attacks; fairly controlled, with three to six attacks; and poorly controlled, with more than six attacks in the past year.

Results: Only 34% of M694V homozygotes were adequately controlled, having had zero to two attacks in the past year, compared to 66% of the patients with all other genotypes combined (p < 0.002). Furthermore, 42% of M694V homozygotes were poorly controlled compared to 13% of all other genotypes combined (p < 0.001). Patients categorized as adequately controlled received a lower dose of colchicine compared to the rest of the cohort (p = 0.042). None of the patients had amyloidosis.

Conclusion: We found a relatively large group of FMF patients with inadequate response to colchicine. This underlines the importance of improving disease control and quality of life for patients with FMF.

Objective: The causative agent behind gouty inflammation, monosodium urate (MSU) crystals, triggers neutrophils to produce reactive oxygen species (ROS) and cast out neutrophil extracellular traps (NETs). We have previously demonstrated that when neutrophils encounter MSU crystals in vitro, they produce ROS that are strictly intracellular, and this response is highly primed in in vivo transmigrated neutrophils. Since neutrophil activation markers in blood have been linked to active gout and cardiovascular events during long-term follow-up, we wanted to further investigate neutrophil activation in gout.

Method: Blood neutrophils from patients with polyarticular gout and healthy controls were tested for activation status, including ROS production, NET formation, and receptor expression. The majority of patients in our study were treated with urate-lowering drugs and some were also treated with colchicine and/or prednisolone. CRP (as a marker of disease activity) and plasma urate levels were measured. Statistical significance was calculated using the Wilcoxon rank-sum test.

Results: Peripheral blood neutrophils from gout patients, similarly to those from healthy controls, displayed a resting phenotype with regard to surface receptor expression, and neither NET formation nor ROS production was primed compared to neutrophils from healthy controls. Levels of ROS production did not correlate with CRP or plasma urate levels, but a trend towards lower intracellular ROS production in colchicine-treated patients was noted.

Conclusions: Blood neutrophils from patients with polyarticular gout do not display an activated phenotype, and respond in a functionally similar way to neutrophils from healthy controls.

Objectives: Early diagnosis is essential to the prognosis of rheumatoid arthritis (RA), but little is known about patients' perceptions of the first symptoms. Illness representations shape patients' help-seeking behaviour. The Illness Perception Questionnaire - Revised (IPQ-R) can measure these, allowing us to understand the patients' role in diagnostic delays. The aim of this study was to explore the connection between RA patients' perceptions of initial symptoms and the time taken to seek help from a general practitioner (GP).

Method: 1163 recently diagnosed individuals with RA, identified from the Danish Rheumatology Database, DANBIO, filled out a questionnaire. We used adjusted multivariable linear regression to calculate the median ratio (MR) for those with the highest scores within each IPQ-R subscale compared to the lowest scores.

Results: Altogether, 404 patients answered the questionnaire. The overall median patient delay was 63 [interquartile range (IQR) 17-214] days. Younger patients experienced longer delays than older [84 (IQR 30-361) vs 54 (14-162) days]. High expectations of treatment control led to 54% lower median time to first GP contact compared to low expectations [adjusted median ratio (MR) 0.54, 95% confidence interval (CI) 0.29-0.99]. High perceptions of symptom variability at disease onset led to a higher median time to first GP contact (adjusted MR 1.61, 95% CI 0.93-2.78).

Conclusion: People with RA symptoms may delay seeing their GP due to low expectations of treatment effectiveness and significant symptom variability. Information campaigns could educate patients on recognizing warning signs and encourage them to seek medical attention.