Early detection of COPD in primary care: the Copenhagen COPD screening project.

Objective: To evaluate the effectiveness of a screening programme for COPD in primary care.

Material/methods: Subjects aged 65 years or older registered with a general practitioner in Copenhagen were asked to complete a questionnaire on smoking status and symptoms of COPD. If they were smokers or former smokers or if morning cough with sputum and/or dyspnoea was present, subjects were defined as "at risk of COPD" and were invited to undergo spirometric examination.

EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis.

Objective: To develop evidence-based recommendations on the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA).

Methods: The task force comprised an expert group of rheumatologists, radiologists, methodologists and experienced rheumatology practitioners from 13 countries. Thirteen key questions on the role of imaging in RA were generated using a process of discussion and consensus.

Postnatal amniotic fluid intake reduces gut inflammatory responses and necrotizing enterocolitis in preterm neonates.

Preterm neonates are susceptible to gastrointestinal disorders such as necrotizing enterocolitis (NEC). Maternal milk and colostrum protects against NEC via growth promoting, immunomodulatory, and antimicrobial factors. The fetal enteral diet amniotic fluid (AF), contains similar components, and we hypothesized that postnatal AF administration reduces inflammatory responses and NEC in preterm neonates.

Clinical response, drug survival, and predictors thereof among 548 patients with psoriatic arthritis who switched tumor necrosis factor α inhibitor therapy: results from the Danish Nationwide DANBIO Registry.

Objective: To describe the frequency of treatment switching and outcomes among patients with psoriatic arthritis (PsA) who switched tumor necrosis factor α inhibitor (TNFi) agents in routine care.

Methods: We conducted an observational cohort study based on the Danish nationwide DANBIO registry. Treatment outcomes were evaluated using the American College of Rheumatology criteria for 20% improvement (ACR20)/ACR50/ACR70, European League Against Rheumatism (EULAR) response criteria for good response, and the 28-joint count Disease Activity Score (DAS28) (remission).

Adalimumab added to a treat-to-target strategy with methotrexate and intra-articular triamcinolone in early rheumatoid arthritis increased remission rates, function and quality of life. The OPERA Study: an investigator-initiated, randomised, double-blind, parallel-group, placebo-controlled trial.

Objectives: An investigator-initiated, double-blinded, placebo-controlled, treat-to-target protocol (Clinical Trials:NCT00660647) studied whether adalimumab added to methotrexate and intra-articular triamcinolone as first-line treatment in early rheumatoid arthritis (ERA) increased the frequency of low disease activity (DAS28CRP<3.2) at 12 months.

Methods: In 14 Danish hospital-based clinics, 180 disease-modifying anti-rheumatic drugs (DMARD)-naïve ERA patients (<6 months duration) received methotrexate 7.

Proceedings from the 5th Annual International Society for Musculoskeletal Imaging in Rheumatology Annual Conference.

Since its inception, ISEMIR has held an annual education meeting highlighting the changes in the utilization of imaging tools for the management of rheumatic diseases. ISEMIR's international faculty and world-renowned experts have discussed these topics at a very high scientific level. The evolution of the content demonstrates the rapidly changing environment in the field of rheumatology.

Escherichia coli challenge in newborn pigs.

Escherichia coli F18 is a common porcine enteric pathogen causing diarrhea and edema in weaned pigs. An essential step in the pathogenesis of this enteric colibacillosis is a fimbria-receptor interaction in the small intestine, involving the α(1,2)-fucosyltransferase gene (FUT1) enzyme for bacterial receptor binding to the epithelium. Enzyme expression is genetically determined and increases after weaning at 3 to5 wk, probably due to age- and/or diet-related intestinal maturation.

MRI comes of age in RA clinical trials.

The success of modern rheumatoid arthritis (RA) therapies and treatment strategies has led to extended placebo phases being unethical in RA randomised controlled trials (RCTs). Modern trials therefore increasingly involve active comparator designs, and this together with some technical issues has meant difficulties in differentiating structural progression using traditional radiographic outcome measures. Magnetic resonance imaging (MRI) has been demonstrated to assess damage more sensitively than radiographs, but importantly it can measure the upstream drivers of erosions and cartilage loss, synovitis and osteitis.

The diagnostic utility of MRI in spondyloarthritis.

The recently developed Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial and peripheral spondyloarthritis (SpA) are the first criteria ever to include findings on magnetic resonance imaging (MRI) of the sacroiliac joints. Features indicating sacroiliac joint inflammation on MRI are weighted equally to structural changes on conventional radiography, and thus MRI has become an important tool for use in daily practice to evaluate patients with clinically suspected early spondyloarthritis. However, MRI can also detect structural changes such as erosions and fat infiltrations, and recent studies suggest that assessment of both inflammatory and structural changes of the sacroiliac joints may improve the diagnostic utility of MRI.

Reliability and responsiveness of dynamic contrast-enhanced magnetic resonance imaging in rheumatoid arthritis.

Objectives: To investigate the responsiveness to treatment and the reliability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in rheumatoid arthritis (RA) knee joints.

Methods: DCE-MRI was performed in 12 clinically active RA knee joints before and 1, 7, 30, and 180 days after intra-articular injection with 80 mg methylprednisolone. Using semi-automated image processing software, DCE-MRI parameters, including the initial rate of enhancement (IRE) and maximal enhancement (ME), were generated for three regions of interest (ROIs): 'Whole slice', 'Quick ROI', and 'Precise ROI'.

Imaging tools in rheumatoid arthritis: ultrasound vs magnetic resonance imaging.

As modern imaging tools such as US and MRI become increasingly available, rheumatologists now have access to highly sensitive measures to assist in the evaluation of both the inflammatory and structural damage components underlying various arthritides over the disease duration. Both US and MRI have associated strengths and weaknesses, and at times they can provide complementary information. This review compares the performance of US vs MRI as diagnostic, prognostic and monitoring tools for RA, and to provide insights into which modality can provide the optimal information for a desired outcome in a given clinical trial or practice situation.

Can imaging be used for inflammatory arthritis screening?

This article reviews the utility of imaging in the diagnostic work-up of suspected and undifferentiated axial and peripheral inflammatory arthritis. Radiographic findings, that is, late damage but not early inflammation, are part of the classification criteria for rheumatoid arthritis (RA), ankylosing spondylitis, spondyloarthritis (SpA), and psoriatic arthritis (PsA), and they are generally part of the early examination program in arthritis. Computed tomography visualizes calcified tissue with high resolution but is rarely used unless radiography is unclear and MRI unavailable.

Development and validation of a magnetic resonance imaging reference criterion for defining a positive sacroiliac joint magnetic resonance imaging finding in spondyloarthritis.

Objective: To validate a magnetic resonance imaging (MRI) reference criterion for a positive sacroiliac (SI) joint MRI finding based on the level of confidence in the classification of spondyloarthritis (SpA) by expert MRI readers.

Methods: Four readers assessed SI joint MRIs in 2 inception cohorts (cohorts A and B) of 157 consecutive patients with back pain ages ≤50 years and 20 age-matched healthy controls. Patients were classified according to clinical examination and pelvic radiography as having nonradiographic axial SpA (n = 51), ankylosing spondylitis (n = 34), or nonspecific back pain (n = 72).

Power Doppler ultrasonography of painful Achilles tendons and entheses in patients with and without spondyloarthropathy: a comparison with clinical examination and contrast-enhanced MRI.

The objective of this study was to describe ultrasonography (US) and magnetic resonance imaging (MRI) findings at painful Achilles tendons and entheses in patients with and without spondyloarthropathy (SpA and non-SpA) and healthy control persons (CTRLs). Particularly, we aimed to investigate if any changes differentiate SpA from non-SpA. Finally, we investigated the reliability of US compared to clinical examination of Achilles tendinopathy, using MRI as gold standard reference.

Consensus statement on blocking the effects of interleukin-6 and in particular by interleukin-6 receptor inhibition in rheumatoid arthritis and other inflammatory conditions.

Background: Since approval of tocilizumab (TCZ) for treatment of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA), interleukin 6 (IL-6) pathway inhibition was evaluated in trials of TCZ and other agents targeting the IL-6 receptor and ligand in various RA populations and other inflammatory diseases. This consensus document informs on interference with the IL-6 pathway based on evidence and expert opinion.

Methods: Preparation of this document involved international experts in RA treatment and RA patients.

GRAPPA 2011: proceedings from the ultrasound imaging module.

In a plenary session at the 2011 meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) the use of sonography for evaluating enthesitis and dactylitis in psoriasis and psoriatic arthritis (PsA) was reviewed, and initial proposals were presented to develop ultrasound joint indices to assess enthesitis and dactylitis in PsA. Sonography can depict ultrastructural morphopathological features of an enthesis and its adjoining tissue structures, as well as increased vascularity; candidate entheses were proposed for an initial sonographic PsA enthesitis index. Ultrasound also can readily demonstrate soft tissue changes, synovitis, erosions, and osteoproliferation in dactylitis, and these features were proposed for an initial sonographic dactylitis index.

Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor α inhibitor therapy: results from the Danish nationwide DANBIO registry.

Objective: To investigate frequencies and reasons for switching, treatment responses and drug survival in patients with ankylosing spondylitis (AS) switching tumour-necrosis-factor-α inhibitor (TNFi) treatment in routine clinical care.

Methods: AS patients were identified in the Danish nationwide DANBIO registry. Disease activity, treatment responses (50% or 20 mm reduction in Bath AS Disease Activity Index (BASDAI)), duration and rates of drug survival and predictors thereof were studied in patients receiving ≥2 different biological drugs.

Structure-based design of a highly constrained nucleic acid analogue: improved duplex stabilization by restricting sugar pucker and torsion angle γ.

Dual conformational restriction: a new, highly constrained modification of the α-L-locked nucleic acid (α-L-LNA) scaffold that locks the sugar furanose ring in an N-type configuration and also restricts rotation around torsion angle γ was synthesized. This new modification increases the thermostability of an oligonucleotide duplex compared to using a single mode of constraint alone.

Imaging in ankylosing spondylitis.

Imaging is an integral part of the management of patients with ankylosing spondylitis and axial spondyloarthritis. Characteristic radiographic and/or magnetic resonance imaging (MRI) findings are key in the diagnosis. Radiography and MRI are also useful in monitoring the disease.

Increased intrathoracic pressure affects cerebral oxygenation following cardiac surgery.

Background: Cerebral oximetry reflects circulatory stability during surgery. We evaluated whether frontal lobe oxygenation is influenced by a transient increase in intrathoracic pressure as induced by a lung recruitment manoeuvre.

Methods: Intrathoracic pressure was increased to 40 cm H(2)O for 20 s immediately after cardiac surgery in ten patients (age 64 ± 10 year, mean ± SD) with frontal lobe oxygenation assessed by near-infrared spectroscopy and cardiac output by thermodilution.

After treat-to-target: can a targeted ultrasound initiative improve RA outcomes?

For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) .

CD6 and syntaxin binding protein 6 variants and response to tumor necrosis factor alpha inhibitors in Danish patients with rheumatoid arthritis.

Background: TNFα inhibitor therapy has greatly improved the treatment of patients with rheumatoid arthritis, however at least 30% do not respond. We aimed to investigate insertions and deletions (INDELS) associated with response to TNFα inhibitors in patients with rheumatoid arthritis (RA).

Methodology And Principal Findings: In the DANBIO Registry we identified 237 TNFα inhibitor naïve patients with RA (81% women; median age 56 years; disease duration 6 years) who initiated treatment with infliximab (n=160), adalimumab (n=56) or etanercept (n=21) between 1999 and 2008 according to national treatment guidelines.

Can erosions on MRI of the sacroiliac joints be reliably detected in patients with ankylosing spondylitis? - A cross-sectional study.

Introduction: Erosions of the sacroiliac joints (SIJ) on pelvic radiographs of patients with ankylosing spondylitis (AS) are an important feature of the modified New York classification criteria. However, radiographic SIJ erosions are often difficult to identify. Recent studies have shown that erosions can be detected also on magnetic resonance imaging (MRI) of the SIJ early in the disease course before they can be seen on radiography.

Childhood asthma in low income countries: an invisible killer?

Bacterial pneumonia has hitherto been considered the key cause of the high respiratory morbidity and mortality in children under five years of age (under-5s) in low-income countries, while asthma has not been stated as a significant reason. This paper explores the definitions and concepts of pneumonia and asthma/wheezing/bronchiolitis and examines whether asthma in under-5s may be confused with pneumonia. Over-diagnosing of bacterial pneumonia can be suspected from the limited association between clinical pneumonia and confirmatory test results such as chest x-ray and microbiological findings and poor treatment results using antibiotics.