Radiofrequency strategies to target peripheral large joint orthopedic pain

2015 ◽  
Vol 19 (3-4) ◽  
pp. 131-137 ◽  
Author(s):  
Jeffrey D. Petersohn
Keyword(s):  
Large Joint

scholarly journals AB0210 ACREULAR: AN R PACKAGE FOR THE CALCULATION AND VISUALISATION OF ACR/EULAR RELATED RHEUMATOID ARTHRITIS MEASURES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1405.1-1406
Author(s):  
F. Morton ◽  
J. Nijjar ◽  
C. Goodyear ◽  
D. Porter
Keyword(s):  
Rheumatoid Arthritis ◽  
Functional Status ◽  
Rheumatic Diseases ◽  
Web Application ◽  
R Package ◽  
Diagnostic Classification ◽  
Microsoft Excel ◽  
Link Type ◽  
Large Joint ◽  
Programming Skills

Background:The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) individually and collaboratively have produced/recommended diagnostic classification, response and functional status criteria for a range of different rheumatic diseases. While there are a number of different resources available for performing these calculations individually, currently there are no tools available that we are aware of to easily calculate these values for whole patient cohorts.Objectives:To develop a new software tool, which will enable both data analysts and also researchers and clinicians without programming skills to calculate ACR/EULAR related measures for a number of different rheumatic diseases.Methods:Criteria that had been developed by ACR and/or EULAR that had been approved for the diagnostic classification, measurement of treatment response and functional status in patients with rheumatoid arthritis were identified. Methods were created using the R programming language to allow the calculation of these criteria, which were incorporated into an R package. Additionally, an R/Shiny web application was developed to enable the calculations to be performed via a web browser using data presented as CSV or Microsoft Excel files.Results:acreular is a freely available, open source R package (downloadable fromhttps://github.com/fragla/acreular) that facilitates the calculation of ACR/EULAR related RA measures for whole patient cohorts. Measures, such as the ACR/EULAR (2010) RA classification criteria, can be determined using precalculated values for each component (small/large joint counts, duration in days, normal/abnormal acute-phase reactants, negative/low/high serology classification) or by providing “raw” data (small/large joint counts, onset/assessment dates, ESR/CRP and CCP/RF laboratory values). Other measures, including EULAR response and ACR20/50/70 response, can also be calculated by providing the required information. The accompanying web application is included as part of the R package but is also externally hosted athttps://fragla.shinyapps.io/shiny-acreular. This enables researchers and clinicians without any programming skills to easily calculate these measures by uploading either a Microsoft Excel or CSV file containing their data. Furthermore, the web application allows the incorporation of additional study covariates, enabling the automatic calculation of multigroup comparative statistics and the visualisation of the data through a number of different plots, both of which can be downloaded.Figure 1.The Data tab following the upload of data. Criteria are calculated by the selecting the appropriate checkbox.Figure 2.A density plot of DAS28 scores grouped by ACR/EULAR 2010 RA classification. Statistical analysis has been performed and shows a significant difference in DAS28 score between the two groups.Conclusion:The acreular R package facilitates the easy calculation of ACR/EULAR RA related disease measures for whole patient cohorts. Calculations can be performed either from within R or by using the accompanying web application, which also enables the graphical visualisation of data and the calculation of comparative statistics. We plan to further develop the package by adding additional RA related criteria and by adding ACR/EULAR related measures for other rheumatic disorders.Disclosure of Interests:Fraser Morton: None declared, Jagtar Nijjar Shareholder of: GlaxoSmithKline plc, Consultant of: Janssen Pharmaceuticals UK, Employee of: GlaxoSmithKline plc, Paid instructor for: Janssen Pharmaceuticals UK, Speakers bureau: Janssen Pharmaceuticals UK, AbbVie, Carl Goodyear: None declared, Duncan Porter: None declared

scholarly journals POS0495 LARGE JOINT DISEASE IN RHEUMATOID ARTHRITIS AND THE ROLE OF RHEUMATOID FACTOR. RESULTS FROM THE EARLY RHEUMATOID ARTHRITIS STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 480-480
Author(s):  
S. S. Zhao ◽  
E. Nikiphorou ◽  
A. Young ◽  
P. Kiely
Keyword(s):  
Rheumatoid Arthritis ◽  
Rheumatoid Factor ◽  
Treatment Strategies ◽  
Treat To Target ◽  
Joint Involvement ◽  
Aggressive Treatment ◽  
Joint Surgery ◽  
Large Joint ◽  
Significant Difference ◽  
Over Time

Background:Rheumatoid arthritis (RA) is classically described as a symmetric small joint polyarthritis with additional involvement of large joints. There is a paucity of information concerning the time course of damage in large joints, such as shoulder, elbow, hip, knee and ankle, from early to established RA, or of the influence of Rheumatoid Factor (RF) status. There is a historic perception that patients who do not have RF follow a milder less destructive course, which might promote less aggressive treatment strategies in RF-negative patients. The historic nature of the Ealy Rheumatoid Arthritis Study (ERAS) provides a unique opportunity to study RA in the context of less aggressive treatment strategies.Objectives:To examine the progression of large joint involvement from early to established RA in terms of range of movement (ROM) and time to joint surgery, according to the presence of RF.Methods:ERAS was a multi-centre inception cohort of newly diagnosed RA patients (<2 years disease duration, csDMARD naive), recruited from 1985-2001 with yearly follow-up for up to 25 (median 10) years. First line treatment was csDMARD monotherapy with/without steroids, favouring sulphasalazine for the majority. Outcome data was recorded at baseline, at 12 months and then once yearly. Patients were deemed RF negative if all repeated assessments were negative. ROM of individual shoulder, elbow, wrist, hip, knee, ankle and hindfeet joints was collected at 3, 5, 9 and 12-15 years. The rate of progression from normal to any loss of ROM, from years 3 to 14 was modelled using GEE, adjusting for confounders. Radiographs of wrists taken at years 0, 1, 2, 3, 5, 7, 9 were scored according to the Larsen method. Change in the Larsen wrist damage score was modelled using GEE as a continuous variable, while the erosion score was dichotomised into present/absent. Surgical procedure data were obtained by linking to Hospital Episodes Statistics and the National Joint Registry. Time to joint surgery was analysed using multivariable Cox models.Results:A total of 1458 patients from the ERAS cohort were included (66% female, mean age 55 years) and 74% were RF-positive. The prevalence of any loss of ROM, from year 3 through to 14 was highest in the wrist followed by ankle, knee, elbow and hip. The proportion of patients at year 9 with greater than 25% loss of ROM was: wrist 30%, ankle 12%, elbow 7%, knee 7% and hip 5%. Odds of loss of ROM increased over time in all joint regions, at around 7 to 13% per year from year 3 to 14. There was no significant difference between RF-positive and RF-negative patients (see Figure 1). Larsen erosion and damage scores at the wrists progressed in all patients; annual odds of developing any erosions were higher in RF-positives OR 1.28 (95%CI 1.24-1.32) than RF-negatives OR 1.17 (95%CI 1.09-1.26), p 0.013. Time to surgery was similar according to RF-status for the wrist and ankle, but RF-positive cases had a lower hazard of surgery at the elbow (HR 0.37, 0.15-0.90), hip (HR 0.69, 0.48-0.99) and after 10 years at the knee (HR 0.41, 0.25-0.68). Adjustment of the models for Lawrence assessed osteoarthritis of hand and feet radiographs did not influence these results.Figure 1.Odds of progression to any loss of ROM (from no loss of ROM) per year in the overall population and stratified by RF status.Conclusion:Large joints become progressively involved in RA, most frequently affecting the wrist followed by ankle, which is overlooked in some composite disease activity indices. We confirm a higher burden of erosions and damage at the wrists in RF-positive patients, but have not found RF-negative patients to have a better prognosis over time with respect to involvement of other large joints. In contrast RF-negative patients had more joint surgery at the elbow, hip, and knee after 10 years. There is no justification to adopt a less aggressive treatment strategy for RF-negative RA. High vigilance and treat-to-target approaches should be followed irrespective of RF status.Disclosure of Interests:None declared

scholarly journals POS0574 RELATIONSHIP BETWEEN INVOLVED JOINT FOR REGION AND MODIFIED HEALTH ASSESSMENT QUESTIONNAIRE SCORE IN JAPANESE PATIENT WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 521.2-521
Author(s):  
I. Yoshii
Keyword(s):  
Health Assessment Questionnaire ◽  
Global Assessment ◽  
Disease Duration ◽  
Health Assessment ◽  
Lower Extremities ◽  
Upper Extremities ◽  
Whole Body ◽  
Large Joint ◽  
Small Joint ◽  
Assessment Questionnaire

Objectives:Rheumatoid arthritis (RA) is a chronic inflammatory disease that involves various joints in whole body. For evaluation of daily life activities (ADL), modified Health Assessment Questionnaire (mHAQ) is usually used. This index configures eight ADL functions these are separated by predominant extremities. This study aimed to evaluate how involved joint affect ADL predominantly in real world setting.Methods:A total of 24,450 times of consultation with RA patient were visited in the institute. Here, patient with RA was interviewed every another visit, and involved joint in whole body, pain score with visual analog scale (PS-VAS), and mHAQ were recorded. Involved joints were divided by four regions in accordance with joint size and part; small joint in upper extremities (US), large joint in upper extremities (UL), small joint in lower extremities (LS), and large joint in lower extremities (LL). mHAQ was also separately evaluated in accordance with predominant regions; upper extremities predominant mHAQ (mHAQ_UE), and lower extremities predominant mHAQ (mHAQ_LE). Adding to these parameters, as an index for disease activity monitoring, components of the simplified disease activity index score (SDAI) was also recorded. Relationship between mHAQ for each predominant extremities, and these parameters and sex, age, disease duration of RA, anti-cyclic citrullinated polypeptide antibodies (ACPA), rheumatoid factor (RF), and Sharp/van der Heijde score (SHS), were statistically evaluated using linear regression analysis.Results:mHAQ_UE significantly correlated with age, ACPA and RF titre, SHS, tenderness joint count (TJC), patient’s global assessment (PGA), evaluator’s global assessment (EGA), C-reactive protein (CRP), US, UL, LL, and PS-vas, whereas mHAQ-LE significantly correlated with all parameters that demonstrated significant correlation with mHAQ-UE and disease duration. mHAQ also correlated with all parameters those that demonstrated significant correlation with mHAQ-LE. Interestingly, all of mHAQ-UE, mHAQ-LE, and mHAQ did not correlated significantly with swollen joint count (SJC) and LS.Conclusion:mHAQ is influenced by various factors, however, SJC and involvement of small joint in lower extremities did not affect mHAQ.Disclosure of Interests:None declared

scholarly journals An orthodontic perspective on Larsen syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Madoka Yasunaga ◽  
Hiroyuki Ishikawa ◽  
Kenichi Yanagita ◽  
Sachio Tamaoki
Keyword(s):  
Foot Deformities ◽  
Dental Arch ◽  
Cephalometric Analysis ◽  
Craniofacial Anomalies ◽  
Nasal Bridge ◽  
Skeletal Morphology ◽  
Larsen Syndrome ◽  
Craniofacial Dysmorphism ◽  
Joint Dislocations ◽  
Large Joint

Abstract Background Larsen syndrome (LS) is a rare disorder of osteochondrodysplasia. In addition to large-joint dislocations, craniofacial anomalies are typical characteristics. In this report, we performed orthodontic analyses, including skeletal and occlusal evaluations, to examine whether the craniofacial skeletal morphology leads to the craniofacial anomalies in LS. Case presentation A 5 year old Japanese girl who was clinically diagnosed with LS was referred to the orthodontic clinic in the Fukuoka Dental College Medical and Dental Hospital because of a malocclusion. Clinical findings at birth were knee-joint dislocations, equinovarus foot deformities, and cleft soft palate. The patient showed craniofacial anomalies with hypertelorism, prominent forehead, depressed nasal bridge, and flattened midface. To evaluate the craniofacial skeletal morphology, cephalometric analysis was performed. In the frontal cephalometric analysis, the larger widths between bilateral points of the orbitale were related to hypertelorism. The lateral cephalometric analysis revealed the midface hypoplasia and the retrognathic mandible. These findings were responsible for the flattened appearance of the patient’s face, even if the anteroposterior position of the nasion was normal. Her forehead looked prominent in relation to the face probably because of the retrognathic maxilla and mandible. Both the study model and the frontal cephalometric analysis indicated constriction of the upper and lower dental arches. The posterior crossbite facilitated by the premature contacts had developed in association with the constriction of the upper dental arch. Conclusions This patient had some craniofacial anomalies with characteristic appearances in LS. It was evident that the underlying skeletal morphology led to the craniofacial dysmorphism.

90Y medical synovectomy for recurrent large joint synovitis

1994 ◽  
Vol 15 (3) ◽  
pp. 205
Author(s):  
M. Nisar ◽  
M. Akil ◽  
R. Whitehorn ◽  
J. Winfield ◽  
A. Martel ◽  
...  
Keyword(s):  
Large Joint

Reparative radiological changes of a large joint after adalimumab for rheumatoid arthritis

2011 ◽  
Vol 30 (4) ◽  
pp. 591-592 ◽  
Author(s):  
Shigeki Momohara ◽  
Eiichi Tanaka ◽  
Takuji Iwamoto ◽  
Katsunori Ikari ◽  
Hisashi Yamanaka
Keyword(s):  
Rheumatoid Arthritis ◽  
Large Joint ◽  
Radiological Changes

Towards Statically Balanced Compliant Joints Using Multimaterial 3D Printing

2014 ◽  
Author(s):  
Arnaud Bruyas ◽  
François Geiskopf ◽  
Pierre Renaud
Keyword(s):  
3D Printing ◽  
Range Of Motion ◽  
Elastic Material ◽  
Geometry Optimization ◽  
Compliant Joints ◽  
Stiffness Properties ◽  
Large Joint ◽  
Hyper Elastic ◽  
Bistable Mechanism ◽  
Novel Design

Compliant joints are widely used in mechanisms when accurate movements are required. With no assembly requested, they are also a great tool for mesoscale robotics, a field in which compactness and large joint amplitudes are necessary features. In this paper, an original multi-material compliant revolute joint is presented. Taking advantage of multi-material 3D printing, it exhibits a novel design with the integration of an hyper-elastic material. Thanks to a helical shape design, a large range of motion is obtained, and the incompressibility of the hyper-elastic material is used to improve the stiffness properties of the joint while keeping it compact. The spring effect of compliant joints makes mechanism actuation more difficult. The proposed joint is therefore designed with an integrated static balancing system in order to minimize actuation torques. The balancing system is composed of a bistable mechanism, which geometry optimization is presented. Experimental assessment demonstrate that the joint possesses a range of motion of 120°, and the balancing system reduces actuation moments by almost 60%.

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