This article comes fro Der Radiologe and is by G Linng and C Schorn from the central Rontgen institute in bad Kreuznach
QUESTION TO ANSWER: Which imaging modalities are appropriate for the Differential diagnosis of Rheumatic diseases.
METHODS AND RESULTS: MRI has far most the highest sensitivity and is unequaled in its brilliant presentation of Anatomy and Pathology. But it is sometimes forgotten, that this is at least in part the result of carefully selected sequences, dedicated to the exspected result.In a method totally independent of any result, this should not be the case. In contrary this method should be highly standardised and regardless what will be the findings. This is true for Plain X-ray. It will be shown, that already the outer sihouette of the soft parts with different features of swelling, and differences in density and even more - defects or appositions of the bony silhouette in the majority of cases at least will allow to classify the patient for a group of diseases and in many cases will lead to a definite diagnosis. Differential diagnoses like Rheumatoid Arthritis versus Psoriatic Arthritis or simply but not always simple - inflammatory Arthritis versus degenerative disease - are allowed to be answered definitely, not always so in MRI. The condition of the subchondral bone can give hints, how advanced and how active the disease is at present.
CONCLUSION: Plain X-ray offers high specifity in the differential diagnoses of rheumatic diseases, it is well standardised and it is a device, to use independent from any suspected findings.So it is the method of choice for questions of differential diagnosis. This is even more true, thinking of the possibility, to investigate all clinically involved regions with not to much extended efforts, wheras MRI and CT are used normally for only one region.
The full abstract and links to the original german article can be found using pubmed, Identifier number is 16673141 and the issue is from May 2006.
Posted in Detection and Prevention May 15th, 2006 by admin | No comments
PURPOSE OF REVIEW: This review addresses recent concerns about the cardiovascular safety of nonsteroidal anti-inflammatory drugs, the disease-modifying role of these drugs in ankylosing spondylitis, and their use in the understudied pediatric population.
RECENT FINDINGS: Several recent observational and controlled studies highlight the cardiovascular toxicity of rofecoxib, celecoxib, parecoxib, valdecoxib and naproxen. Concerns about cardiovascular safety raise questions about the chronic use of nonsteroidal anti-inflammatory drugs in patients with rheumatic diseases, including children. The risks of these drugs in the pediatric population are not well known and this review addresses the limited data available concerning nonsteroidal anti-inflammatory drug use in children. A recent trial in ankylosing spondylitis patients demonstrated continuous nonsteroidal anti-inflammatory drug use reduced the rate of syndesmophyte formation, suggesting that they may have a disease-modifying role in these patients.
SUMMARY: Nonsteroidal anti-inflammatory drugs have been in the spotlight this year. While preliminary evidence has supported novel roles for these drugs in ankylosing spondylitis and in cancer prevention, accumulating evidence shows that some cyclooxygenase-2 and perhaps all nonsteroidal anti-inflammatory drugs are associated with cardiovascular toxicity. Further research is needed to understand the magnitude and mechanism of this risk. Clinicians are compelled to weigh carefully the benefits and risks of therapy. Concerns about safety are balanced by optimism about their potential role in delaying the progression of ankylosing spondylitis.
Abstract taken from Ardoin and Sundy
pubmed ID 16582683
Curr Opin Rheumatol 2006 May;18(3):221-6.
Posted in Detection and Prevention April 11th, 2006 by admin | No comments
Clinicians often push the message of how important that it is to intervene early in the development of inflammatory arthritis in order to better control the condition in the long term. There are many ways that inflammatory arthritis can be detected at an early stage these include analyzing images. Though only 20% of patients who are suffering from the condition can be detected as having inflammatory arthritis when using radiographs, this number can increase to over 80% detection when magnetic resonance imaging is used. Over seven times the number of synovitis can be detected when using ultrasonography techniques as when using radiographs. The use of immunology and genetics also serves as a useful guide in the early detection of Arthritis.
Antibody association
There are many things that are associated with the disease, these include class II HLA and there is evidence for explicit autoantibiotics, anticyclic citrullinated peptides and a series of amino acids known as an epitope having a major impact on the disease. Indeed there is much evidence that these factors are associated with the strength of rheumatoid factor.
As these antibodies may be present years before arthritis can properly be detected they may prove very useful for immunological testing in the early stages of the development of the disease. As these antibodies are very specific in comparison to rheumatoid factor they are likely to aid in the easing of both short and long term suffering of arthritis patients.
Posted in Detection and Prevention February 14th, 2006 by admin | No comments
