İlknur Aktaş

The role of multi-parametric MR imaging in the detection of early inflammatory sacroiliitis according to ASAS criteria

PURPOSEnTo retrospectively evaluate the accuracy of multi-parametric magnetic resonance (MR) imaging including fat saturated (FS) T2-weighted, short-tau inversion recovery (STIR), diffusion-weighted (DW-MR), and dynamic-contrast-enhanced MR (DCE-MR) imaging techniques in the diagnosis of early inflammatory sacroiliitis and determine the additional value of DW-MR and DCE-MR images according to recently defined Assessment in SpondyloArthritis international Society criteria.nnnMATERIALS AND METHODSnThe study included 45 patients with back pain. Two radiologists estimated the likelihood of osteitis in 4 independent viewing sessions including FS T2-weighted, STIR, DW-MR and DCE-MR images. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) were calculated.nnnRESULTSnOf the 45 patients, 31 had inflammatory back pain. Of 31, 28 (90.3%) patients had inflammatory sacroiliitis diagnosed by clinical and laboratory analysis. FS T2-weighted MR images had the highest sensitivity (42.8% for both radiologists) for detecting osteitis in patients with inflammaory sacroiliitis when compared to other imaging sequences. For specificity, PPV, NPV, accuracy, and AUC levels there were no statistically significant difference between image viewing settings. However, adding STIR, DW-MR and DCE-MR images to the FS T2-weighted MR images did not improve the above stated indices.nnnCONCLUSIONnFS T2-weighted MR imaging had the highest sensitivity when compared to other imaging sequences. The addition of DW-MR and DCE-MR images did not significantly improve the diagnostic value of MR imaging in the diagnosis of osteitis for both experienced and less experienced radiologists.

New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy

AbstractnUlnar nerve entrapment at the elbow (UNE) is the second most common entrapment neuropathy of the arm. Conservative treatment is the treatment of choice in mild to moderate cases. Elbow splints and avoiding flexion of the involved elbow constitute majority of the conservative treatment; indeed, there is no other non-invasive treatment modality. The aim of this study was to investigate the efficacy of ultrasound (US) and low-level laser therapy (LLLT) in the treatment of UNE to provide an alternative conservative treatment method. A randomized single-blind study was carried out in 32 patients diagnosed with UNE. Short-segment conduction study (SSCS) was performed for the localization of the entrapment site. Patients were randomized into US treatment (frequency of 1xa0MHz, intensity of 1.5xa0W/cm2, continuous mode) and LLLT (0.8xa0J/cm2 with 905xa0nm wavelength), both applied five times a week for 2xa0weeks. Assessments were performed at baseline, at the end of the treatment, and at the first and third months by visual analog scale, hand grip strength, semmes weinstein monofilament test, latency change at SSCS, and patient satisfaction scale. Both treatment groups had significant improvements on clinical and electrophysiological parameters (pxa0<xa00.05) at first month with no statistically significant difference between them. Improvements in all parameters were sustained at the third month for the US group, while only changes in grip strength and latency were significant for the LLLT group at third month. The present study demonstrated that both US and LLLT provided improvements in clinical and electrophysiological parameters and have a satisfying short-term effectiveness in the treatment of UNE.

SAT0595 Effectiveness of short wave diathermy treatment in patients with subacromial impingement syndrome and value of night pain on patient selection: a double-blind, randomized, placebo-controlled trial

Background Shoulder impingement syndrome (SIS) is a common causes of shoulder pain and the night pain is a frequent symptom of this condition (1,2). Short wave diathermy (SWD) is a deep diathermic agents used in the treatment of musculoskeletal system disorders. Local inflammation could be the major cause of night pain, and using a deep diathermic modality might be contradictory. Objectives Investigation of the effectiveness of short wave diathermy SWD treatment in patient with SIS and to emphasize the significance of night pain (NP) status on treatment response. Methods In this double-blind, randomized placebo controlled trial, 57 patients aged between 35 to 65 years, diagnosed as SIS were classified into two groups as night pain positive NP(+) (n=28) and night pain negative NP(-) (n=29). Both groups were randomly assigned to SWD treatment NP(+) n=14, NP(-) n=14 and sham NP(+) n=15, NP (-) n=14 subgroups. Exercise, cold pack application and a non-steroidal anti-inflammatory drug treatment were applied to all groups. 27.12 MHz continuous SWD (daily 20 min per session, 5 days per week, for 2 weeks, 10 sessions) was applied to the treatment groups while sham SWD was applied to the sham groups with the same protocol. Rest, activity and night visual analog scale (VAS), Constant (Murley) Score (CS) and Shoulder Disability Questionnaire (SDQ) were used for evaluation of patients at 2 weeks before the treatment, 1 month and 2 months after the treatment. Results There were no statistical differences between the SWD treatment and sham groups in all outcome parameters except for the Constant pain scores in NP (+) group. In NP(-) group, SWD treatment improved the parameters of pain, strength, total scores of CS, and SDQ compared to sham group at 1 month. SWD treatment was superior to sham for all parameters except for the Constant daily living activity scores at 2 months. Conclusions In conclusion, addition of 27.12 MHz continuous SWD treatment to conventional therapies provides long term benefits when compared to sham SWD in terms of rest and activity VAS scores, Constant-Murley scores, and SDQ scores in SIS patients without night pain. However, there was no convincing evidence that SWD treatment is of additional benefit in SIS patients with NP. Therefore; night pain as a symptom should be regarded in the selection of treatment modalities in order to use the deep heaters effectively in the management of SIS. References Van der Windt DA, Koes BW, de Jong BA, Bouter LM (1995) Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 54(12), 959–964. Minns Lowe CJ, Moser J, Barker K (2014) Living with a symptomatic rotator cuff tear “bad days, bad nights”: a qualitative study. BMC Musculoskelet Disord 15:228. Disclosure of Interest None declared

AB0034 Parameters of total blood count; might they be indicators of inflammation in rheumatoid arthritis and ankylosing spondylitis?

Background Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are launched as recent markers of inflammation in chronic inflammation principally in cancer and cardiovascular diseases (1–2). Objectives Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory disorders marked by variable periods of remissions and relapses.Inflammation is most likely the underlying cause in disability, increased comorbidity therefore need to be closely monitored and kept under control (3).For this reason cost effective, accessible and reliable parameters are needed in daily practice. Our aim is to analyze the relation between inflammation and NLR and PLR which are easily calculated from whole blood count parameters. Methods Medical records of 425 subjects were analyzed retrospectively.Mean age of the subjects was 44,64±14,07 years (17–89 years),52.9% was female (n=225) and 47.1% was male (n=200).105 of them had RA, 216 of them had AS and 104 were healthy controls.2010 ACR/EULAR classification criteria and modified New York criteria were used for the diagnosis of RA and AS.Erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and whole blood count were recorded with simultaneous DAS28 scores of patients with RA and BASDAI scores of patients with AS. Results Hemoglobin levels of RA patients were significantly (p<0.05) lower then the levels of control group (p=0.001).ESR, CRP, NLR and PLR were significantly higher then the control group respectively (p=0.001, p=0.001, p=0.001, p=0.040).In AS group hemoglobin, ESR, CRP and NLR values were significantly higher then the control group respectively (p=0.001, p=0.006, p=0.001, p=0.001). No difference was detected between AS and control groups in terms of PLR (p>0.05).When patients with high disease activity and patients in remission were compared for both RA and AS groups ESR (p=0.001, p=0.001) and CRP scores (p=0.005, p=0.003) were significantly lower respectively. No statistical significance was found in terms of NLR and PLR (p>0.05).Significant positive correlation was found in RA patients with high disease activity between ESR, CRP, NLR and PLR. In AS patients with high disease activity significant positive correlation was found between ESR, NLR and PLR. No correlation was found between disease activity indices, NLR and PLR. Conclusions With the advantage of cost effectiveness and easy calculation NLR and PLR in RA patients, and NLR in AS patients might be used as indicators of inflammation together with ESR and CRP or instances when they are not applicable.Although NLR and PLR are useful in the discrimination of healthy and diseased subjects, they are not sufficient to determine disease activity because not only laboratory parameters but clinical findings and self assessment of the patient are also included in activity measurement. References Yang HB, Xing M, Ma LN, Feng LX, Yu Z.Prognostic significance of neutrophil-lymphocyte ratio/platelet-lymphocyte ratio in lung cancers:a meta-analysis. Oncotarget. 2016 Nov 22;7(47):76769–76778. Wiwanitkit V. Neutrophil-to-Lymphocyte Ratio,Platelet-to-Lymphocyte Ratio and Heart Failure.Arq Bras Cardiol. 2016 Mar;106(3):265. Mercan R, Bitik B, Tufan A, Bozbulut UB, Atas N, Ozturk MA, Haznedaroglu S, Goker B. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal. 2016 Sep;30(5):597–601. Disclosure of Interest None declared

FRI0648 Concordance between the tuberculin skin test and interferon gamma release assay for diagnosing latent tuberculosis infection in patients with chronic inflammatory arthritis

Background Biologic therapies have led to a dramatic change in the management of rheumatologic diseases. Although biologic agents provide profound clinical benefits, various adverse events are associated with their use particularly an increased risk of the reactivation of latent tuberculosis. Therefore, screening for latent tuberculosis infection (LTBI) is imperative before initiating biologic agents1. Although tuberculin skin test (TST) is the most common test for detecting LTBI, Bacillus Calmette-Guerin (BCG) vaccination and non-tuberculosis Mycobacterium infections, can lead to false positive TST results. Interferon-gamma release assay (IGRA) measures the immune response to tuberculosis specific antigens that do not cross react with BCG, and therefore, do not cause false positive reactions in BCG recipients. Its positiveness indicates the presence of tuberculosis infection either latent or active2. Objectives We aimed to prevent the unnecessary anti-tuberculosis prophylaxis in patients whom biologic therapy is planned by evaluating the concordance between the TST and IGRA. Methods Patients who have been receiving biologic therapy due to chronic inflammatory arthritis were enrolled in this study. Demographic and clinical data, TST and IGRA results were recorded. The agreement between IGRA and TST results was evaluated by Kappa coefficient. Results A total of 35 patients were included; 15 (42.8%) were male and mean age was 43.74±12.72 years. Of the 22 TST positive patients, 13 (37.1%) were IGRA negative. Of the 13 TST negative patients, 3 (8.6%) were IGRA positive. Nine (25.7%) patients were positive for either of the two tests and 10 (28.6%) patients were negative for both tests. There was statistically significant discordance between two tests (p:0.021; p<0.05) (Table 1). While positive rate of TST was 62.9%, positive rate of IGRA was 34.3% and Kappa consistency coefficient between two tests was 15.4% (p:0.283; p>0.05).Table 1. Agreement between IGRA and TST results IGRA TST Total p Negative n (%) Positive n (%) n (%) Negative 10 (28.6) 13 (37.1) 23 (65.7) 0.021 Positive 3 (8.6) 9 (25.7) 12 (34.3) Total 13 (37.1) 22 (62.9) Conclusions It is very common in rheumatology practice to administer anti-tuberculosis prophylaxis according to the TST. IGRA may reduce the number of patients in whom tuberculostatics are prescribed, especially in BCG recipients in endemic populations, resulting in a benefit of avoiding possible side effects. Furthermore, IGRA is also important for detecting the cases of LTBI that would be missed by TST. Confirmation in larger studies is necessary. References Costantino F, de Carvalho Bittencourt M, Rat AC, et al. Screening for latent tuberculosis infection in patients with chronic inflammatory arthritis: discrepancies between tuberculin skin test and interferon-γ release assay results. J Rheumatol. 2013 Dec;40(12):1986–93. Ruan Q, Zhang S, Ai J, et al. Screening of latent tuberculosis infection by interferon-γ release assays in rheumatic patients: a systemic review and meta-analysis. Clin Rheumatol. 2016 Feb;35(2):417–25. Disclosure of Interest None declared