Bente Jensen

Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow

The purpose of this study was to investigate the treatment response in lateral epicondylitis (tennis elbow) by MRI. Magnetic resonance imaging was obtained in 30 patients with clinical symptoms of lateral epicondylitis of the elbow using T1-, T2- and T2-weighted fat-saturated (FS) sequences. The patients were randomised to either i.m. corticosteroid injection (n=16) or immobilisation in a wrist splint (n=14). Magnetic resonance imaging of the elbow was performed on a 1.5-T MR system at baseline and after 6xa0weeks. The extensor carpi radialis (ECRB) tendon, the radial collateral ligament, lateral humerus epicondyle at tendon insertion site, joint fluid and signal intensity changes within brachio-radialis and anconeus muscles were evaluated on the MR unit’s workstation before and after 6xa0weeks of treatment. The MRI was performed once in 22 healthy controls for comparison and all images evaluated by an investigator blinded to the clinical status of the subjects. The MR images showed thickening with separation of the ECRB tendon from the radial collateral ligament and abnormal signal change in 25 of the 30 patients on the T1-weighted sequences at inclusion. The signal intensity of the ECRB tendon was increased in 24 of the 30 patients with lateral epicondylitis of the elbow on the T2-weighted FS sequences. In the patients there were no associations between pathologically signal intensity within the ECRB tendon on T1- and T2-weighted sequences and the degree of self-reported pain (Dumbells test) at inclusion. In general, the MRI changes persisted in the patients at follow-up after 6xa0weeks despite clinical remission. The increased signal intensity within the extensor tendon is indicative of lateral epicondylitis humeri. The changes in signal intensity and morphology of ECRB tendon seem to be chronic and may persist despite clinical improvement.

Rheumatic Manifestations in Danish Women with Silicone Breast Implants

Abstract The aim of this study was to investigate whether women with silicone breast implants (SBI) present with a unique rheumatic symptomatology. We assessed the profile of rheumatic disease in six groups of women identified through Danish hospital and population registers, three groups of women with a prior hospital diagnosis of muscular rheumatism (a non-specific diagnostic code) who had previously undergone SBI surgery (nu2009=u200928), breast reduction surgery (nu2009=u200929) or no breast surgery (nu2009=u200927); and three groups of women without a diagnosis of muscular rheumatism who had undergone SBI surgery (nu2009=u200921), breast reduction surgery (nu2009=u200927) or no breast sugery (nu2009=u200956). All women in the study population (nu2009=u2009188) underwent a thorough clinical examination, blood tests and a personal interview. In all study groups soft-tissue rheumatism and degenerative diseases were the most frequent diagnoses. Women with a prior diagnosis of muscular rheumatism but no prior breast surgery had a significantly higher prevalence of soft-tissue rheumatism than those with breast implant or reduction surgery. No significant differences in the frequencies of rheumatic diseases were observed among the three groups of women without previous muscular rheumatism. No specific pattern of inflammatory rheumatic disorders or soft-tissue complaints was identified among the women with SBI, and blood tests for autoimmunity revealed no unique pattern. Overall, women with earlier rheumatism had significantly increased frequencies of rheumatic conditions than did those without. We found no evidence of a rheumatic symptomatology unique to women with silicone breast implants. Our study emphasises the need for consideration of prior rheumatic disease when evaluating rheumatic manifestations in women with SBI.

Bone mineral density in fibromyalgia patients: correlation to disease activity

Objective: To compare bone mass (BMD) in women with fibromyalgia (FM) with healthy females, and to evaluate whether self‐reported pain and lack of functional capacity correlate to reduced BMD in FM patients. Methods: Thirty‐one FM patients (20 pre‐ and 11 postmenopausal) and fourty‐one healthy women (30 pre‐ and 10 postmenopausal) were enrolled in the study. BMD of the lumbar spine and the femoral neck was measured by a DEXA (Norland) scanner. Self reported pain was measured on a Visual Analog Scale (VAS). The Activity of Daily Living (ADL) component of the Fibromyalgia Impact Questionnaire (FIQ‐ADL) was used as measure for physical capacity. Results: BMD‐lumbar spine and BMD‐femoral neck did not differ significantly between FM patients and controls, though premenopausal FM patients tended to have lower BMD‐femoral neck (p=0.09). Selfreported pain and FIQ‐ADL among FM patients correlated with BMD‐femoral neck (rs=−0.52, p=0.003); (rs=−0.31, p=0.09). Conclusion: Premenopausal FM patients tended to have lower BMD of hip than controls. Selfreported pain correlated negatively to BMD. Thus, the severity of FM might have a negative impact on bone mass.

Correlation Between Tender Points and the Fibromyalgia Impact Questionnaire

Objectives: To investigate a possible correlation between the number of tender points [TePs] and the myalgic score versus the Activities of Daily Living [ADL] items and the pain visual analog scale [VAS] of the Fibromyalgia Impact Questionnaire [FIQ]. Methods: Consecutive patients with fibromyalgia were included [N = 221; 213 females, eight males, mean age 46 years]. The diagnosis was established using the criteria of the American College of Rheumatology: widespread pain for at least three months and pain on palpation in at least 11 out of 18 specified TeP locations. A 4-point (0–3) scale of pain severity was used. Each patient was evaluated by the number of TePs and by a myalgic score expressed by the summation of the pain severity score multiplied by the respective number of TePs. Before the clinical examination the patients filled in the FIQ. The first 10 subitems of the FIQ, measuring physical functioning [FIQ-ADL], were used. Results: The FIQ-ADL was correlated to the following parameters: pain on the VAS [rs = 0.46; P < 0.001], the myalgic score [rs = 0.30; P < 0.001], and the number of TePs [rs = 0.20; P = 0.003]. Some correlation between the myalgic score and pain on the VAS was seen [rs = 0.15; P = 0.004]. We found no correlation between the number of TePs and pain on the VAS. Conclusion: As an indicator of disability the myalgic score appears to be preferable to the number of TePs. Self-reported pain is correlated to the physical function as expressed by the FIQ-ADL.

Search for Borna disease virus in Danish fibromyalgia patients

Objective: The purpose of this study was to look for Borna disease virus (BDV) in 18 patients with acute onset of fibromyalgia (FMS) following a ?flu-like? episode. BDV is a neurotropic RNA virus affecting horses and sheep. Infections in animals have been reported to cause immune mediated disease characterized by abnormalities in behavior. A possible link between BDV and neuropsychiatric diseases in man has been described, and lately a connection to chronic fatigue syndrome (CFS) has been suggested. Methods: A BDV-specific nested PCR (RT-PCR) was performed on serum and spinal fluid. Results: The BDV genome was not detected in any of the FMS cases. Conclusion: Although BDV was not demonstrated in spinal fluid or serum from the tested patients with FMS, we believe that it is important to report our results, since FMS can exhibit many manifestations in common with CFS. Possible reasons for the discrepant findings are discussed.OBJECTIVEnThe purpose of this study was to look for Borna disease virus (BDV) in 18 patients with acute onset of fibromyalgia (FMS) following a flu-like episode. BDV is a neurotropic RNA virus affecting horses and sheep. Infections in animals have been reported to cause immune mediated disease characterized by abnormalities in behavior. A possible link between BDV and neuropsychiatric diseases in man has been described, and lately a connection to chronic fatigue syndrome (CFS) has been suggested.nnnMETHODSnA BDV-specific nested PCR (RT-PCR) was performed on serum and spinal fluid.nnnRESULTSnThe BDV genome was not detected in any of the FMS cases.nnnCONCLUSIONnAlthough BDV was not demonstrated in spinal fluid or serum from the tested patients with FMS, we believe that it is important to report our results, since FMS can exhibit many manifestations in common with CFS. Possible reasons for the discrepant findings are discussed.

Self-Reported Symptoms among Danish Women following Cosmetic Breast Implant Surgery

Abstract The aim of this study was to examine self-reported symptomatology and to identify distinctive characteristics among women with silicone breast implants (SBI). Using the Danish hospital and population registers we identified three groups of women with a hospital diagnosis of muscular rheumatism (a non-specific soft-tissue diagnostic code) who had previously undergone SBI surgery (n= 28), breast reduction surgery (n= 29) or no breast surgery (n= 27); and three groups of women without a diagnosis of muscular rheumatism who had undergone SBI surgery (n= 21), breast reduction surgery (n= 27) or no breast surgery (n= 56). All study subjects completed a self-administered questionnaire focusing on sociodemographic factors, lifestyle habits, somatic symptoms and psychological symptoms. Women with SBI and women with breast reduction with no previous diagnosis of muscular rheumatism had similar patterns of reporting for most symptoms and characteristics. They reported significantly more somatic symptoms and psychological distress, including somatisation, obsessive–compulsiveness and depression, than women with no breast surgery. No significant differences in self-reported symptomatology and characteristics were observed among the three groups of women with a previous diagnosis of muscular rheumatism. Overall, women with prior muscular rheumatism reported more symptoms than those without. We concluded that self-reported somatic symptoms among women with SBI were similar to those of controls. Women with cosmetic breast surgery appear to have distinctive psychological characteristics. Our study emphasises the importance of taking the psychological profile and previous history of rheumatic diseases into account when examining women with SBI.

The use of synthetic peptides for detection of anti-citrullinated protein antibodies in rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology. A characteristic feature of RA is the presence of anti-citrullinated protein antibodies (ACPA). Since ACPAs are highly specific for RA and are often present before the onset of RA symptoms, they have become valuable diagnostic and prognostic. As a result, several assays for detection of ACPAs exist, which vary in sensitivity and specificity. In this study, we analyzed the reactivity of RA sera to selected peptides by solid-phase immunoassays in order to develop an ACPA assay with improved sensitivity and specificity. ACPA levels were determined with respect to sensitivity and specificity in 332 serum samples using the newly developed peptide panel, which was compared to the commercial assays CCPlus (Eurodiagnostica) and CCP3.1 (Inova Diagnostics). A primary panel (peptides 814, 33062 and 33156) was identified, which obtained a sensitivity of 71%, while the complete peptide panel reacted with 79% of RA sera screened. Total specificities of 89% and 80% were obtained for the primary peptide panel and the complete peptide panel. Sensitivities for the commercial assays ranged between 71% and 76% and specificities between 88% and 90%. These findings indicate that the generated peptide panel is optimal for ACPA detection and able to compete with commercial available assays. Collectively, this study may contribute to characterize autoimmunity towards citrullinated proteins and to the development of new and improved diagnostic assays for detection of ACPA and determination of RA.