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Hochberg M.C.,University of Maryland Baltimore County | Martel-Pelletier J.,University of Montréal | Monfort J.,Hospital Del Mar | Monfort J.,IMIM Hospital Del Mar Medical Research Institute | And 15 more authors.
Annals of the Rheumatic Diseases | Year: 2016

Objectives To compare the efficacy and safety of chondroitin sulfate plus glucosamine hydrochloride (CS+GH) versus celecoxib in patients with knee osteoarthritis and severe pain. Methods Double-blind Multicentre Osteoarthritis interVEntion trial with SYSADOA (MOVES) conducted in France, Germany, Poland and Spain evaluating treatment with CS+GH versus celecoxib in 606 patients with Kellgren and Lawrence grades 2-3 knee osteoarthritis and moderate-To-severe pain (Western Ontario and McMaster osteoarthritis index (WOMAC) score ≥301; 0-500 scale). Patients were randomised to receive 400 mg CS plus 500 mg GH three times a day or 200 mg celecoxib every day for 6 months. The primary outcome was the mean decrease in WOMAC pain from baseline to 6 months. Secondary outcomes included WOMAC function and stiffness, visual analogue scale for pain, presence of joint swelling/effusion, rescue medication consumption, Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria and EuroQoL-5D. Results The adjusted mean change (95% CI) in WOMAC pain was -185.7 (-200.3 to -171.1) (50.1% decrease) with CS+GH and -186.8 (-201.7 to -171.9) (50.2% decrease) with celecoxib, meeting the non-inferiority margin of -40: -1.11 (-22.0 to 19.8; p=0.92). All sensitivity analyses were consistent with that result. At 6 months, 79.7% of patients in the combination group and 79.2% in the celecoxib group fulfilled OMERACT-OARSI criteria. Both groups elicited a reduction >50% in the presence of joint swelling; a similar reduction was seen for effusion. No differences were observed for the other secondary outcomes. Adverse events were low and similarly distributed between groups. Conclusions CS+GH has comparable efficacy to celecoxib in reducing pain, stiffness, functional limitation and joint swelling/effusion after 6 months in patients with painful knee osteoarthritis, with a good safety profile.


Balius R.,Sport Catalan Council | Rodas G.,F.C. Barcelona Medical Services | Pedret C.,Clinica CMI Diagonal | Capdevila L.,Autonomous University of Barcelona | And 2 more authors.
Skeletal Radiology | Year: 2014

Objective: To assess the sensitivity of ultrasound in detecting soleus muscle lesions diagnosed on magnetic resonance imaging (MRI) and to characterize their location, ultrasound pattern, and evolution. Materials and methods: Ultrasound and MRI studies were performed between May 2009 and February 2013 on all patients who presented to the Medical Services Clinic of the Catalan Sport Council with the initial onset of sharp pain in the calf compatible with injury of the soleus muscle. An inter-observer ultrasound reliability study was also performed. Results: A total of 55 cases of soleus injury were studied prospectively (22 with right leg involvement, 33 left) by ultrasound and MRI, which was utilized as the “gold standard.” In MRI studies, 24 cases (43.7 %) had myofascial injuries that were localized in the posterior aponeurosis (PMF) in 15 cases (27.3 %) and in the anterior aponeurosis (AMF) in 9 (16.4 %). Thirty-one cases (56.3 %) were musculotendinous injuries, with 9 cases (16.4 %) in the medial aponeurosis (MMT), 11 cases (20 %) in the lateral aponeurosis (LMT), and 11 cases (20 %) in the central tendon (CMT). In comparison to MRI, ultrasound was able to detect injury to the soleus in 27.2 % of cases. No injuries were detected by ultrasound alone. Posterior myofascial injuries were more likely to be detected by ultrasound than anterior myofascial injuries or all types of musculotendinous injuries. Ultrasound patterns for each type of injury were described. Conclusion: Ultrasound is not a sensitive technique for detecting and assessing soleus traumatic tears compared with MRI, although the sensitivity is enhanced by a thorough anatomically based ultrasound examination. Timing of the ultrasound examination may be of importance. Each type of soleus injury appears to have a characteristic ultrasound pattern based on a defect of connective expansions, the existence of small myofascial filiform collections, and the rarefaction of the fibrillar area. © 2014, ISS.


Naredo E.,Complutense University of Madrid | D'Agostino M.A.,University of Versailles | Wakefield R.J.,University of Leeds | Moller I.,Instituto Poal Of Reumatologia | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Objective To produce consensus-based scoring systems for ultrasound (US) tenosynovitis and to assess the intraobserver and interobserver reliability of these scoring systems in rheumatoid arthritis (RA). Methods We undertook a Delphi process on US-defined tenosynovitis and US scoring system of tenosynovitis in RA among 35 rheumatologists, experts in musculoskeletal US (MSUS), from 16 countries. Then, we assessed the intraobserver and interobserver reliability of US in scoring tenosynovitis on B-mode and with a power Doppler (PD) technique. Ten patients with RA with symptoms in the hands or feet were recruited. Ten rheumatologists expert in MSUS blindly, independently and consecutively scored for tenosynovitis in B-mode and PD mode three wrist extensor compartments, two finger flexor tendons and two ankle tendons of each patient in two rounds in a blinded fashion. Intraobserver reliability was assessed by Cohen's ê. Interobserver reliability was assessed by Light's ê. Weighted ê coefficients with absolute weighting were computed for B-mode and PD signal. Results Four-grade semiquantitative scoring systems were agreed upon for scoring tenosynovitis in B-mode and for scoring pathological peritendinous Doppler signal within the synovial sheath. The intraobserver reliability for tenosynovitis scoring on B-mode and PD mode was good (ê value 0.72 for B-mode; ê value 0.78 for PD mode). Interobserver reliability assessment showed good ê values for PD tenosynovitis scoring (first round, 0.64; second round, 0.65) and moderate ê values for B-mode tenosynovitis scoring (first round, 0.47; second round, 0.45). Conclusions US appears to be a reproducible tool for evaluating and monitoring tenosynovitis in RA.


PubMed | Hospital General Of Villalba, Instituto Poal Of Reumatologia, Servicio Andaluz de Salud, Hospital Universitario La Paz and 11 more.
Type: | Journal: Reumatologia clinica | Year: 2016

To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA).Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted 7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist.A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies.These recommendations will help clinicians use US and MRI in RA patients.


PubMed | Complutense University of Madrid, Military Medical Hospital, Diakonhjemmet Hospital, University of Versailles and 8 more.
Type: Consensus Development Conference | Journal: Annals of the rheumatic diseases | Year: 2016

To assess whether ultrasonography (US) is reliable for the evaluation of inflammatory and structural abnormalities in patients with knee osteoarthritis (OA).Thirteen patients with early knee OA were examined by 11 experienced sonographers during 2days. Dichotomous and semiquantitative scoring was performed on synovitis characteristics in various aspects of the knee joint. Semiquantitative scoring was done of osteophytes at the medial and lateral femorotibial joint space or cartilage damage of the trochlea and on medial meniscal damage bilaterally. Intra- and interobserver reliability were computed by use of unweighted and weighted coefficients.Intra- and interobserver reliability scores were moderate to good for synovitis (mean 0.67 and 0.52, respectively) as well as moderate to good for the global synovitis (0.70 and 0.50, respectively). Mean intra- and interobserver reliability for cartilage damage, medial meniscal damage and osteophytes ranged from fair to good (0.55 and 0.34, 0.75 and 0.56, 0.73 and 0.60, respectively).Using a standardised protocol, dichotomous and semiquantitative US scoring of pathological changes in knee OA can be reliable.


De la Fuente J.,Clinica Pakea de Mutualia | Miguel-Perez M.I.,University of Barcelona | Balius R.,Consell Catala de lesport | Guerrero V.,Clinica Pakea de Mutualia | And 2 more authors.
Journal of Clinical Ultrasound | Year: 2013

Background.: Carpal tunnel syndrome is a common condition frequently requiring surgical intervention. We describe a new minimally invasive surgical technique for carpal tunnel release utilizing ultrasound (US) visualization. Methods.: The technique was performed on 20 fresh frozen cadaver specimens. A surgical metallic probe with a "U"-shaped trough and upward curved distal tip was precisely positioned in the carpal tunnel with US guidance followed by division of the flexor retinaculum (FR) with a "V"-shaped scalpel. Results.: Complete division of the FR was confirmed by US. Dissection performed on the specimens confirmed complete release of FR and absence of neurovascular injury. The distance from the division of the FR to these structures, the "safety margins," was measured. Conclusions.: This new technique for carpal tunnel release appears to combine the safety and efficacy of open carpal tunnel surgery with the advantages of the minimally invasive techniques. © 2012 Wiley Periodicals, Inc.


Sanchez J.,University of the Balearic Islands | Bonet M.L.,University of the Balearic Islands | Keijer J.,Wageningen University | Van Schothorst E.M.,Wageningen University | And 4 more authors.
Genes and Nutrition | Year: 2014

The aim of the study was to explore peripheral blood gene expression as a source of biomarkers of joint health improvement related to glycosaminoglycan (GAG) intake in humans. Healthy individuals with joint discomfort were enrolled in a randomized, double-blind, placebo-controlled intervention study in humans. Subjects ate control yoghurt or yoghurt supplemented with a recently authorized novel food in Europe containing hyaluronic acid (65%) from rooster comb (Mobilee™ as commercial name) for 90 days. Effects on functional quality-of-life parameters related to joint health were assessed. Whole-genome microarray analysis of peripheral blood samples from a subset of 20 subjects (10 placebo and 10 supplemented) collected pre- and post-intervention was performed. Mobilee™ supplementation reduced articular pain intensity and synovial effusion and improved knee muscular strength indicators as compared to placebo. About 157 coding genes were differentially expressed in blood cells between supplemented and placebo groups post-intervention, but not pre-intervention (p < 0.05; fold change ≥ 1.2). Among them, a reduced gene expression of glucuronidase-beta (GUSB), matrix metallopeptidase 23B (MMP23B), xylosyltransferase II (XYLT2), and heparan sulfate 6-O-sulfotransferase 1 (HS6ST1) was found in the supplemented group. Correlation analysis indicated a direct relationship between blood cell gene expression of MMP23B, involved in the breakdown of the extracellular matrix, and pain intensity, and an inverse relationship between blood cell gene expression of HS6ST1, responsible for 6-O-sulfation of heparan sulfate, and indicators of knee muscular strength. Expression levels of specific genes in blood cells, in particular genes related to GAG metabolism and extracellular matrix dynamics, are potential biomarkers of beneficial effects on articular health. © Springer-Verlag 2014.


Iagnocco A.,University of Rome La Sapienza | Conaghan P.G.,University of Leeds | Aegerter P.,University of Versailles | Moller I.,Instituto Poal Of Reumatologia | And 7 more authors.
Osteoarthritis and Cartilage | Year: 2012

Objective: To assess the reliability of ultrasound (US) in detecting cartilage abnormalities at the metacarpo-phalangeal (MCP) joints in people with cartilage pathology. Methods: Nine expert ultrasonographers initially achieved consensus on definitions and scanning protocols. They then examined the second to fifth MCP joints of the dominant hand of eight people with hand osteoarthritis (OA). US examinations were conducted in two rounds, with independent blinded evaluations of cartilage lesions. Global cartilage abnormalities were assessed by applying a dichotomous (presence/absence) score; in addition, the following lesions were evaluated using the same scoring system: loss of anechoic structure and/or thinning of the cartilage layer, and irregularities and/or loss of sharpness of at least one cartilage margin. Reliability was assessed using kappa (k) coefficients. Results: Thirty-two joints were examined. Intra-observer k values ranged from 0.52 to 1 for global cartilage abnormalities; k values ranged from 0.54 to 0.94 for loss of anechoic structure and/or thinning of cartilage layer and from 0.59 to 1 for irregularities and/or loss of sharpness of at least one cartilage margin. Values of k for inter-observer reliability were 0.80 for global cartilage abnormalities, 0.62 for loss of anechoic structure and/or thinning of cartilage layer, and 0.39 for irregularities and/or loss of sharpness of at least one cartilage margin. Conclusion: US is a reliable imaging modality for the detection of cartilage abnormalities in patients with cartilage pathology in the MCP joints. The analysis of specific cartilage measures showed more variable results that may be improved by modifying definitions and further standardization of US techniques. © 2012 Osteoarthritis Research Society International.


Moller I.,Instituto Poal Of Reumatologia | Saenz I.,University of Barcelona
Current Rheumatology Reviews | Year: 2011

Musculoskeletal ultrasound (US) is an important part of rheumatologic practice and requires a thorough understanding of the anatomic details of the involved structures. In this article, we present three clinically relevant examples whose diagnosis and treatment are greatly enhanced by US examination. The subsheath surrounding the extensor carpi ulnaris tendon is an important structure that stabilizes the tendon and can be confused with pathologic changes. The pulleys of the flexor tendons of the fingers that are commonly involved in patients with rheumatologic disorders and are readily visible on high-resolution US, should be part of the routine evaluation of these patients. Lateral hip pain is a frequent presentation and US enables us to recognize the actual etiology of this problem. © 2011 Bentham Science Publishers Ltd.


PubMed | Consell Catala de lEsport, Clinica Diagonal, Hospital Asepeyo and Instituto Poal Of Reumatologia
Type: Journal Article | Journal: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine | Year: 2016

Chronic exertional compartment syndrome is characterized by exertional pain and elevated intracompartmental pressures affecting the leg in physically active young people. In patients who have failed conservative measures, fasciotomy is the treatment of choice. This study presents a new method for performing fasciotomy using high-resolution ultrasound (US) guidance and reports on the clinical outcomes in a group of these patients. Over a 3-year period, 7 consecutive patients with a total of 9 involved legs presented clinically with anterior compartment chronic exertional compartment syndrome, which was confirmed by intracompartmental pressure measurements before and after exercise. After a US examination, fasciotomy under US guidance was performed. Preoperative and postoperative pain and activity levels were assessed as well as number of days needed to return to play. All patients had a decrease in pain, and all except 1 returned to presymptomatic exercise levels with a median return to play of 35 days.

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