- 作者列表："Ogul H","Tas N","Ay M","Kose M","Kantarci M
OBJECTIVE:To describe the posterior labral lesions and labrocapsular abnormalities of the shoulder on sonoarthrography and to compare these findings with MR arthrography results. METHODS:82 shoulders were initially evaluated with ultrasonography and MRI and then were examined with sonoarthrography and MR arthrography following intraarticular injection of diluted gadolinium solution. The ultrasonography images were prospectively evaluated for the presence of posterior labral tear, sublabral cleft, and posterior capsular abnormalities by two radiologists. The diagnostic accuracy of sonoarthrography in the detection of posterior labral tears and posterior labrocapsular variants was compared with that of MR arthrography. RESULTS:In sonoarthrographic examinations of 82 shoulders, 5 and 6 posterior labral tears were identified by Observer 1 and 2, respectively. Moreover, 6 and 7 posterior sublabral clefts, and 2 and 3 posterior synovial folds were identified by Observer 1 and 2, respectively. All the 82 patients were examined with MR arthrography; however, only 14 patients underwent arthroscopic examination. No significant difference was found among the 82 patients with regard to age, gender, and the prevalence of posterior labral tear, posterior labral cleft, and posterior synovial fold (p > 0.05). Interobserver variability showed substantial agreement between the sonoarthrographic and MR arthrographic results of the posterior labrocapsular structures (κ = 0.71, p < 0.05). CONCLUSION:Posterior labral tears and posterior synovial folds of the shoulder joint can be evaluated non-invasively by sonoarthrography. ADVANCES IN KNOWLEDGE:Variations and pathologies of posterior labrocapsular structures of the glenohumeral joint are relatively uncommon.Direct (MR) arthrography is the gold-standard imaging modality to evaluate of posterior labrocapsular abnormalities of the glenohumeral joint.Sonoarthrography of the glenohumeral joint may be utilized in clinical practice in patients with contraindications to (MRI).
目的: 描述肩关节后lab唇病变和唇包膜异常的超声造影表现，并与MR造影结果进行比较。 方法: 对 82 例肩关节进行超声和MRI初步评价，然后在关节内注射稀释的钆溶液后进行超声和MR关节造影检查。由两名放射科医生前瞻性评价超声图像是否存在后唇撕裂、后唇裂和后囊畸形。将超声关节造影检出后lab唇撕裂和后lab唇囊变异的诊断准确性与MR关节造影进行比较。 结果: 在 82 例肩关节的超声造影检查中，观察者 1 和 2 分别鉴定出 5 例和 6 例后唇撕裂。此外，观察者 1 和 2 分别鉴定出 6 和 7 个后abral裂，2 和 3 个后滑膜皱襞。82 例患者均行MR关节造影检查; 但仅 14 例患者行关节镜检查。82 例患者在年龄、性别、唇后撕裂、唇后裂和后滑膜皱襞的患病率方面差异无统计学意义 (p> 0.05)。观察者间变异性显示后阴唇囊结构的声关节造影和MR关节造影结果之间有实质性的一致性 (κ = 0.71，p <0.05)。 结论: 声关节造影可无创性评价肩关节后唇撕裂和后滑膜皱襞。 知识进步: 盂肱关节后唇包膜结构的变异和病理相对少见。直接 (MR) 关节造影是评价盂肱关节后唇包膜异常的金标准成像方式。对于有MRI禁忌症的患者，盂肱关节的超声造影可用于临床实践。
METHODS:OBJECTIVE:Patients with immune-mediated inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus are at increased risk of cardiovascular disease. However, the cardiovascular risk of patients with primary Sjögren's syndrome (SS) remains poorly studied. We aimed to investigate the association between primary SS and cardiovascular morbidity and mortality. METHODS:We performed a systematic review of articles in Medline and the Cochrane Library and recent abstracts from US and European meetings, searching for reports of randomized controlled studies of cardiovascular morbidity and cardiovascular mortality in primary SS. The relative risk (RR) values for cardiovascular morbidity and mortality associated with primary SS were collected and pooled in a meta-analysis with a random-effects model by using Review Manager (Cochrane collaboration). RESULTS:The literature search revealed 484 articles and abstracts of interest; 14 studies (67,124 patients with primary SS) were included in the meta-analysis. With primary SS versus control populations, the risk was significantly increased for coronary morbidity (RR 1.34 [95% confidence interval (95% CI) 1.06-1.38]; P = 0.01), cerebrovascular morbidity (RR 1.46 [95% CI 1.43-1.49]; P < 0.00001), heart failure rate (odds ratio 2.54 [95% CI 1.30-4.97]; P < 0.007), and thromboembolic morbidity (RR 1.78 [95% CI 1.41-2.25]; P < 0.00001), with no statistically significant increased risk of cardiovascular mortality (RR 1.48 [95% CI 0.77-2.85]; P = 0.24). CONCLUSION:This meta-analysis demonstrates that primary SS is associated with increased cardiovascular morbidity, which suggests that these patients should be screened for cardiovascular comorbidities and considered for preventive interventions, in a multidisciplinary approach with cardiologists.
METHODS:OBJECTIVE:We aimed to evaluate the comparative risk of hospitalized infection among patients with rheumatoid arthritis (RA) who initiated abatacept versus a tumor necrosis factor inhibitor (TNFi). METHODS:Using claims data from Truven MarketScan database (2006-2015), we identified patients with RA ages ≥18 years with ≥2 RA diagnoses who initiated treatment with abatacept or a TNFi. The primary outcome was a composite end point of any hospitalized infection. Secondary outcomes included bacterial infection, herpes zoster, and infections affecting different organ systems. We performed 1:1 propensity score (PS) matching between the groups in order to control for baseline confounders. We estimated incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) for hospitalized infection. RESULTS:We identified 11,248 PS-matched pairs of patients who initiated treatment with abatacept and TNFi with a median age of 56 years (83% were women). The IR per 1,000 person-years for any hospitalized infection was 37 among patients who initiated treatment with abatacept and 47 in those who initiated treatment with TNFi. The HR for the risk of any hospitalized infection associated with abatacept versus TNFi was 0.78 (95% CI 0.64-0.95) and remained lower when compared to infliximab (HR 0.63 [95% CI 0.47-0.85]), while no significant difference was seen when compared to adalimumab and etanercept. The risk of secondary outcomes was lower for abatacept for pulmonary infections, and similar to TNFi for the remaining outcomes. CONCLUSION:In this large cohort of patients with RA who initiated treatment with abatacept or TNFi as a first- or second-line biologic agent, we found a lower risk of hospitalized infection after initiating abatacept versus TNFi, which was driven mostly by infliximab.
METHODS:OBJECTIVE:Reducing pain is one of the main health priorities for children and young people with juvenile idiopathic arthritis (JIA); however, some studies indicate that pain is not routinely assessed in this patient group. The aim of this study was to explore health care professionals' (HCPs) beliefs about the role of pain and the prioritization of its assessment in children and young people with JIA. METHODS:Semi-structured interviews were conducted with HCPs who manage children and young people with JIA in the UK (including consultant and trainee pediatric rheumatologists, nurses, physical therapists, and occupational therapists). Data were analyzed qualitatively following a framework analysis approach. RESULTS:Twenty-one HCPs participated. Analyses of the data identified 6 themes, including lack of training and low confidence in pain assessment, reluctance to engage in pain discussions, low prioritization of pain assessment, specific beliefs about the nature of pain in JIA, treatment of pain in JIA, and undervaluing pain reports. Assessment of pain symptoms was regarded as a low priority and some HCPs actively avoided conversations about pain. CONCLUSION:These findings indicate that the assessment of pain in children and young people with JIA may be limited by knowledge, skills, and attitudinal factors. HCPs' accounts of their beliefs about pain in JIA and their low prioritization of pain in clinical practice suggest that a shift in perceptions about pain management may be helpful for professionals managing children and young people with this condition.