Viktoria Fana

Purpose: To investigate the diagnostic performance of ultrasound, 2‐deoxy‐2‐[ ¹⁸ F]fluoro‐D‐glucose positron emission tomography/computed tomography (2‐[ ¹⁸ F]FDG PET/CT) and temporal artery biopsy (TAB) in giant cell arteritis (GCA). Methods: This was a prospective single‐centre diagnostic accuracy study ( ClinicalTrials.gov NCT05248906). One hundred and ten patients suspected of GCA were considered, of which 103 were analysed, 100 had a final diagnosis and 58 had complete data for all modalities. Ultrasound, 2‐[ ¹⁸ F]FDG PET/CT and TAB were performed after clinical examination and blood sampling. The main outcome included diagnostic accuracy measures with final clinical expert diagnosis at 6‐month follow‐up as the comparator. Results: Sixty‐one patients had GCA, 39 had non‐GCA and 3 had inconclusive. The sensitivities were 82% (95% CI: 66%–92%), 74% (95% CI: 57%–87%) and 68% (95% CI: 51%–83%) for ultrasound, 2‐[ ¹⁸ F]FDG PET/CT and TAB, respectively. The corresponding specificities were 90% (95% CI: 68%–99%), 100% (95% CI: 83%–100%) and 100% (95% CI: 83%–100%), the positive predictive values 94% (95% CI: 81%–98%), 100% (95% CI: 88%–100%) and 100% (95% CI: 87%–100%), the negative predictive values 72% (95% CI: 57%–84%), 67% (95% CI: 54%–77%) and 63% (95% CI: 51%–73%) and accuracies 85% (95% CI: 73%–93%), 83% (95% CI: 71%–91%) and 79% (95% CI: 67%–89%). When ultrasound was inconclusive, 2‐[ ¹⁸ F]FDG PET/CT had a higher sensitivity of 75% (95% CI: 35%–97%) vs. 38% (95% CI: 9%–76%) for TAB, with equal specificity of 100% (both 95% CI: 69%–100%). Results were inconclusive in 22 of 99 ultrasounds, 3 of 102 2‐[ ¹⁸ F]FDG PET/CTs and 4 of 90 TABs. Conclusion: Ultrasound had high diagnostic accuracy for GCA, supporting this as the first imaging modality in suspected GCA. 2‐[ ¹⁸ F]FDG PET/CT combined a high diagnostic accuracy with fewer inconclusive results, suggesting it may be used for second‐line testing when ultrasound is inconclusive, reserving TAB for third‐line testing. A fast‐track setup may facilitate efficient diagnostics.

Objective: Salivary gland ultrasound (SGUS) is a non-invasive tool for the evaluation of parenchymal changes related to primary Sjögrens disease (pSjD) with the potential to reduce the need for minor salivary gland biopsies when diagnosing patients with pSjD. The aim was to assess the agreement between SGUS findings and minor salivary gland biopsy results in patients suspected of pSjD. Methods: All patients referred with a suspicion of pSjD and scheduled for a diagnostic minor salivary gland biopsy were included in the period 2017–2021. All underwent SGUS of the parotid and submandibular glands bilaterally, Schirmer’s test, unstimulated salivary flow, and blood samples including autoantibody analysis. Changes in the four glands were scored 0–3 using a previously developed ultrasound atlas based on the OMERACT SGUS scoring system for pSjD. All biopsies were scored at the same pathology department and a focus score > 1 was indicative of pSjD. Results: Of 103 patients included, 43 (42%) were diagnosed with pSjD and 40 (39%) fulfilled the 2016 ACR/EULAR classification criteria. Thirty-two (31%) had a positive minor salivary gland biopsy. The sensitivity of SGUS score ≥ 2 in at least 1 gland was 0.59 and the specificity 0.75. The positive predictive and negative predictive values were 0.51 and 0.80, respectively. The agreement slightly improved when combined with an abnormal salivary flow rate or abnormal Schirmer’s test. Conclusion: In patients with suspected pSjD, we found good agreement between the OMERACT SGUS scoring system and minor salivary gland biopsy; however, SGUS cannot yet fully replace biopsy in the diagnostic setup of SjD.

INTRODUCTION: In patients with inflammatory bowel disease (IBD), co-occurring spondyloarthritis (SpA) leads to poorer outcomes and impaired quality of life, highlighting the importance of early detection and effective treatment. This is the first study to assess the prevalence and distribution of axial symptoms and magnetic resonance imaging (MRI)-detected involvement of the spine and sacroiliac joints (SIJs) in early IBD. METHODS: Newly diagnosed patients with IBD from a prospective, population-based cohort were consecutively recruited. Rheumatological interview, clinical, ultrasound, and MRI assessment for SIJ and spine inflammatory and structural lesions were made using validated scoring methods and consensus definitions of axial SpA (axSpA). RESULTS: Of 110 patients (ulcerative colitis: 70, Crohn's disease: 40, mean age of 42 years, and 40% male), 48 (44.9%) reported back and/or buttock pain, and 10 (9.1%) had inflammatory back pain. Seventeen (16.7%) patients had MRI findings indicative of axSpA; only 10 of these patients had axial symptoms. Inflammatory MRI lesions were present in SIJs and the spine of 27 (26.5%) and 30 (30.3%) patients, respectively. The Assessment of SpondyloArthritis International Society classification criteria for axSpA were met in 11 (10%) cases. MRI findings typical of axSpA were associated with peripheral joint and entheseal inflammation detected by ultrasound (P = 0.04). No differences in clinical or imaging findings were found between patients with ulcerative colitis and Crohn's disease. DISCUSSION: One-in-6 newly diagnosed patients with IBD had MRI findings indicative of axSpA. As 40% of these patients were asymptomatic, this suggests that axSpA is underdiagnosed in early IBD. Multidisciplinary collaboration is essential to ensure early detection of axial inflammation and to enable optimal therapy preventing future structural damage and disability.

Background: Subclinical synovitis by ultrasound is a frequent finding in rheumatoid arthritis (RA) patients in remission and has been shown to be related to erosive progression, risk of flare and unsuccessful drug tapering, but it has not been investigated how a DAS28 T2T-steered strategy in routine care affects the presence of subclinical synovitis in RA patients in remission. The aim of the current study was to investigate the presence of ultrasound-detected subclinical inflammation in RA patients in long-term remission receiving either biological or conventional disease-modifying anti-rheumatic drugs (bDMARD/csDMARD) and, finally, to investigate the presence of ultrasound remission using different ultrasound remission criteria. Methods: Eighty-seven RA patients (42 patients receiving bDMARD and 45 csDMARD) received DAS28-CRP-steered treatment in routine care and had achieved DAS28-CRP-remission for > 1 year without radiographic progression. Twenty-four joints were scored 0–3 by ultrasound (elbows, wrists, knees, ankles, metacarpophalangeal and metatarsophalangeal joints 2–5) for grey-scale synovial hypertrophy (GS) and colour Doppler activity (CD) using the OMERACT scoring system. Ultrasound remission was defined as strict (GS score = 0 and CD score = 0), semi-strict (GS score < 1 and Doppler score = 0) and Doppler remission (Doppler score = 0). Results: No differences between treatment groups were found for GS sum score and Doppler sum score (median (range) 6 (0–19) and 0 (0–12), respectively). A Doppler score > 0 in at least 1 joint was seen in 44%, a GS score > 1 in at least 1 joint in 93% and a GS score > 2 in at least 1 joint in 54% of patients. Strict ultrasound remission was only observed in bDMARD patients (7%; p = 0.01). Thirty-seven per cent were in semi-strict ultrasound remission and 56% in Doppler remission (no significant difference between groups) with similar results across the subgroups of patients who also fulfilled the ACR-EULAR Boolean-, CDAI- and SDAI-remission criteria. Conclusions: Ultrasound frequently detected subclinical synovitis in RA patients in longstanding DAS28-remission obtained through a DAS28-CRP-steered strategy. This was independent of treatment and applied ultrasound remission criteria. Strict ultrasound remission was rare.

Objective The aim of this study was to compare the efficacy of intramuscular versus ultrasound (US)-guided intratenosynovial glucocorticoid injection in providing disease control after 2, 4 and 12 weeks in patients with rheumatoid arthritis(RA) with tenosynovitis. Methods Fifty patients with RA and tenosynovitis were randomised into two double-blind groups: (A) ‘intramuscular group’, receiving intramuscular injection of betamethasone and US-guided intratenosynovial isotonic saline injection and (B) ‘intratenosynovial group’ receiving saline intramuscularly and US-guided intratenosynovial betamethasone injection. All patients were in stable disease-modifying anti-rheumatic drug treatment prior to and during the study. Patients were excluded, and considered non-responders, if any treatments were altered during the follow-up period. ‘US tenosynovitis remission’, defined as US tenosynovitis grey-scale score ≤1 and colour Doppler score=0, was assessed at week 4 (primary outcome), and weeks 2 and 12, using non-responder imputation for missing data. Results US tenosynovitis remission at week 4 was achieved in 25% (6/24) in the ‘intramuscular group’ versus 64% (16/25) in the ‘intratenosynovial group’, that is, a difference of −39 percentage point (pp) (CI −65pp to −13pp), Fisher exact test p=0.001. Corresponding values for the ‘intramuscular group’ versus the ‘intratenosynovial group’ at 2 and 12 weeks were 21% (5/24) versus 48% (13/25), that is, a difference of −27pp (CI −53pp to −2pp), p=0.072 and 8% (2/24) versus 44% (11/25), that is, difference of −36pp (−58pp to −13pp), p=0.003. Most US, clinical and patient-reported scores improved more in the ‘intratenosynovial group’ at all follow-up visits. Conclusions In this randomised double-blind clinical trial, patients with RA and tenosynovitis responded significantly better to US-guided intratenosynovial glucocorticoid injection than to intramuscular glucocorticoid injection, both at 4 and 12 weeks follow-up. Trial registration number EudraCT nr: 2013-003486-34.