Účel studie: Radiosynoviortéza (RSO), dříve též nazývána slovem radiosynovektomie (RS), je metoda zaměřená na léčbu bolesti a otoku kloubů způsobených synovitidou u artritid a dekompenzovaných artróz prostřednictvím lokální aplikace beta zářičů. Zářením vyvolaná povrchová nekróza části buněk v synoviální membráně ve svém výsledku může zmírnit bolest, snížit otoky a zlepšit funkci kloubů. Materiál a metoda: V období 2013–2024 bylo RSO léčeno celkem 436 pacientů, z toho 291 pro otok kolenního kloubu vzniklý v důsledku dekompenzované artrózy a 172 kvůli artritidě. Kolenní kloub byl RSO ošetřen 268krát a malé a střední klouby 50krát. Používalo se yttrium u kolenních kloubů, rhenium u středních nebo erbium u malých kloubů. Samotný zákrok spočíval v punkci kloubu a odsátí případného kloubního výpotku, následné aplikaci radiofarmaka a imobilizaci kloubu po dobu 2–3 dnů. Výsledky: K hodnocení klinického efektu RSO jsme vybrali aplikace v letech 2022 a 2023. V roce 2022 bylo provedeno 45 ošetření a v roce 2023 dalších 26. Po jednom roce bylo 61 % pacientů s léčbou kolenních kloubů zcela spokojeno, přičemž uváděli zmenšení otoku a zlepšení rozsahu pohybu. U pacientů léčených s malými a středně velkými klouby se celkové zlepšení objevilo u 57 % z nich. Někteří zaznamenali recidivující výpotek menšího objemu nebo jen částečné zlepšení. Závěr: Radiosynoviortéza je účinná léčba otoků a bolesti kloubů způsobených synovitidou s pozitivními výsledky jak u kolenních, tak i menších kloubů, což je doloženo jak objektivními, tak subjektivními zlepšeními.

Purpose of the study: Radiosynoviorthesis (RSO), previously also called radiosynovectomy (RS), is a method focused on the treatment of joint pain and swelling caused by synovitis in arthritis and decompensated osteoarthrosis using beta emitters. Radiation-induced surface necrosis of part of the cells in the synovial membrane can, as a result, relieve pain, reduce swelling, and improve joint function. Material and method: Between 2013-2024, 436 patients were treated with RSO, primarily for knee joint swelling due to decompensated osteoarthrosis (291 patients) and arthritis (172 patients). RSO was performed on the knee (268 cases) and on small/medium joints (50 cases), using yttrium for knee joints, rhenium for medium joins or erbium for small joints. The procedure involved puncture of the joint and suction of any joint effusion, injecting the radioactive isotope, and subsequently immobilizing the joint for 2–3 days. Results: We selected treatments in 2022 and 2023 to evaluate the clinical effect of RSO. In 2022, 45 treatments were performed, and in 2023 another 26. One year post-treatment, 61 % of patients with knee joint involvement were fully satisfied, reporting reduced swelling and improved range of motion. Among patients treated for small and medium-sized joints, 57 % experienced overall improvement. Some patients observed recurring effusions of smaller volume or only partial improvement. Conclusion: Radiosynoviorthesis is an effective treatment for joint swelling and pain caused by synovitis, with positive outcomes seen in knee as well as smaller joints. Both objective and subjective assessments confirmed significant benefits.

• Keywords
• radiosynoviortéza,
• MeSH
• Arthritis diagnostic imaging   radiotherapy   MeSH
• Erbium administration & dosage   therapeutic use   MeSH
• Injections, Intra-Articular MeSH
• Clinical Trials as Topic MeSH
• Osteoarthritis diagnostic imaging   radiotherapy   MeSH
• Radiopharmaceuticals * administration & dosage   therapeutic use   MeSH
• Yttrium Radioisotopes administration & dosage   therapeutic use   MeSH
• Rhenium administration & dosage   therapeutic use   MeSH
• Synovitis * diagnostic imaging   radiotherapy   MeSH

OBJECTIVES: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.

• MeSH
• Delphi Technique MeSH
• Adult MeSH
• Enthesopathy diagnostic imaging   MeSH
• Finger Joint * diagnostic imaging   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Cadaver MeSH
• Observer Variation MeSH
• Fingers diagnostic imaging   pathology   MeSH
• Arthritis, Psoriatic * diagnostic imaging   MeSH
• Reproducibility of Results MeSH
• Aged MeSH
• Feasibility Studies MeSH
• Severity of Illness Index * MeSH
• Synovitis diagnostic imaging   pathology   MeSH
• Tenosynovitis diagnostic imaging   MeSH
• Ultrasonography * methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Validation Study MeSH

OBJECTIVES: The aim of the present study was to propose a methodologically innovative sonographic approach for optimal evaluation of synovial tissues (starting from histopathology). METHODS: Using high-frequency ultrasound probes and high-level ultrasound machines, we matched the histological microarchitecture of synovial tissues with multiple sonographic patterns in physiological and pathological conditions. Likewise, high-sensitive color/power Doppler assessments have also been performed to evaluate the microcirculation. RESULTS: Modern equipment allows for a macroscopic classification of synovial pathologies recognizing different morphological patterns; however, intimal and subintimal layers of the synovium cannot be distinguished from each other on ultrasound. High-sensitive Doppler imaging clearly defines the microvascular pattern, especially in patients with hypertrophic synovial pathologies. CONCLUSIONS: In clinical practice, using adequate technological equipment i.e. high-frequency B-mode and high-sensitive Doppler imaging, detailed sonographic assessment of synovial tissues can be performed - defining the main sono-histological patterns.

• MeSH
• Humans MeSH
• Arthritis, Rheumatoid * pathology   MeSH
• Muscles pathology   MeSH
• Synovial Membrane diagnostic imaging   blood supply   pathology   MeSH
• Synovitis * diagnostic imaging   pathology   MeSH
• Ultrasonography MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: In the ULTIMATE study with an open label extension, we assessed the long-term effect of secukinumab at tissue level on synovitis and enthesitis, and across all psoriatic arthritis (PsA) manifestations, using both clinical evaluations and power Doppler ultrasonography (PDUS). METHODS: This randomised, placebo-controlled, Phase 3 study (ULTIMATE) included biologic-naïve patients with PsA with active PDUS synovitis and clinical enthesitis, and inadequate response to conventional synthetic disease-modifying antirheumatic drugs. The study consisted of 3 treatment periods; in the first period (baseline to week 12) patients were randomised to receive subcutaneous secukinumab (150 mg or 300 mg according to severity of skin psoriasis) or placebo every week until week 4 and once every 4 weeks up to week 12. In the second period (weeks 12-24) all patients received open-label secukinumab with placebo patients switching to secukinumab (150 mg or 300 mg). The third period (weeks 24-52) was an extended open-label treatment period. The long-term responsiveness of the Global EULAR-OMERACT Synovitis Score (GLOESS), clinical enthesitis and global PDUS-detected enthesitis score (using two candidate definitions of activity) at patient level, together with clinical efficacy across key manifestations of PsA and safety were assessed. RESULTS: Of the 166 patients enrolled, 144 completed week 52. A significant reduction in GLOESS was demonstrated in the secukinumab group vs placebo at week 12, followed by a stable reduction of synovitis until week 52 in the secukinumab group while placebo switchers from week 12 reached a similar level of reduction at week 24 with stability thereafter. Likewise, a significant reduction in the Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index was shown in the secukinumab group vs placebo at week 12 with sustained improvement to week 52. Global OMERACT PDUS enthesitis scores were numerically lower in secukinumab vs placebo switchers in the first two treatment periods, with some stability in the third period in both groups. Improvements in clinical responses were also observed across all key domains of PsA up to week 52 in both treatment groups with no new or unexpected safety signals. CONCLUSIONS: ULTIMATE showed consistent improvements in clinically and ultrasound-assessed synovitis and enthesitis and sustained clinical efficacy through week 52 in patients with PsA treated with secukinumab and placebo switched to secukinumab.

• MeSH
• Antirheumatic Agents * adverse effects   MeSH
• Double-Blind Method MeSH
• Enthesopathy * diagnostic imaging   drug therapy   MeSH
• Antibodies, Monoclonal, Humanized adverse effects   MeSH
• Humans MeSH
• Arthritis, Psoriatic * complications   diagnostic imaging   drug therapy   MeSH
• Synovitis * diagnostic imaging   drug therapy   chemically induced   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial, Phase III MeSH
• Randomized Controlled Trial MeSH

Hypotéza: Muskuloskeletální ultrasonografie (MSUS) dětí s juvenilní idiopatickou artritidou (JIA) umožní identifikaci subklinické synovitidy i strukturálního poškození kloubů a významně přispěje k monitoraci onemocnění a optimalizaci terapie při menší zátěži pacienta i zdravotnického systému. Senzitivita MSUS pro synovitidu může mít srovnatelnou výpovědní hodnotu s magnetickou rezonancí (MR). Hlavní cíle: Zavedení a standardizace MSUS kloubů u dětí s JIA. Stanovení spektra fyziologických nálezů na MSUS. Stanovení klinické významnosti MSUS změn, standardizace hodnocení patologických nálezů. Definice sonografických parametrů kloubní remise. Metody: MSUS bude prováděna dvěma školenými operátory: u pacientů bez kloubního onemocnění v 6 věkových kategoriích a u pacientů s jakýmkoli podtypem aktivní JIA. Srovnání MSUS nálezů na klinicky aktivních kloubech dětí s JIA a na zdravých kloubech kontrol stejného věku. Porovnání klinického kloubního nálezu s MSUS a MR, korelace se standardizovanými parametry aktivity JIA, funkčního omezení a kvality života (JADAS, JAMAR, PedsQL, CHAQ).; Hypothesis: The identification of subclinical synovitis and structural damage in the joints by musculoskeletal ultrasonography (MSUS) in children with juvenile idiopathic arthritis (JIA) will contribute to the monitoring and optimizing of therapy with less burden for the patient and healthcare system. MSUS sensitivity for synovitis may have predictive value as MR imaging. Main objectives: The introduction and standardization MSUS of joints in children with JIA. Determining the range of MSUS physiological findings. Determining the clinical significance of MSUS changes and standardization of pathological findings. MSUS criteria for the remission in joint. Methods: MSUS will be performed by two trained operators: in patients without joint disease in six age-related categories and in patients with any subtype of active JIA. Comparison MSUS findings in clinically active joints in JIA and joints of healthy controls of the same age. Comparison of the clinical findings in joints with MSUS and MR and correlation with standardized parameters JIA activity, functional limits, quality of life.

• MeSH
• Child MeSH
• Arthritis, Juvenile diagnostic imaging   MeSH
• Cartilage, Articular MeSH
• Magnetic Resonance Imaging MeSH
• Synovitis diagnostic imaging   MeSH
• Ultrasonography, Doppler methods   MeSH
• Inflammation MeSH
• Check Tag
• Child MeSH

• Conspectus
• Pediatrie
• NML Fields
• pediatrie
• ortopedie
• revmatologie
• NML Publication type
• závěrečné zprávy o řešení grantu AZV MZ ČR

OBJECTIVES: To investigate the dynamics of response of synovitis to IL-17A inhibition with secukinumab in patients with active PsA using Power Doppler ultrasound. METHODS: The randomized, placebo-controlled, Phase III ULTIMATE study enrolled PsA patients with active ultrasound synovitis and clinical synovitis and enthesitis having an inadequate response to conventional DMARDs and naïve to biologic DMARDs. Patients were randomly assigned to receive either weekly subcutaneous secukinumab (300 or 150 mg according to the severity of psoriasis) or placebo followed by 4-weekly dosing thereafter. The primary outcome was the mean change in the ultrasound Global EULAR and OMERACT Synovitis Score (GLOESS) from baseline to week 12. Key secondary endpoints included ACR 20 and 50 responses. RESULTS: Of the 166 patients enrolled, 97% completed 12 weeks of treatment (secukinumab, 99%; placebo, 95%). The primary end point was met, and the adjusted mean change in GLOESS was higher with secukinumab than placebo [-9 (0.9) vs -6 (0.9), difference (95% CI): -3 (-6, -1); one-sided P=0.004] at week 12. The difference in GLOESS between secukinumab and placebo was significant as early as one week after initiation of treatment. All key secondary endpoints were met. No new or unexpected safety findings were reported. CONCLUSION: This unique ultrasound study shows that apart from improving the signs and symptoms of PsA, IL-17A inhibition with secukinumab leads to a rapid and significant reduction of synovitis in PsA patients. TRIAL REGISTRATION: ClinicalTrials.gov; NCT02662985.

• MeSH
• Antirheumatic Agents * therapeutic use   MeSH
• Double-Blind Method MeSH
• Antibodies, Monoclonal, Humanized MeSH
• Interleukin-17 MeSH
• Humans MeSH
• Antibodies, Monoclonal adverse effects   MeSH
• Arthritis, Psoriatic * complications   diagnostic imaging   drug therapy   MeSH
• Synovitis * diagnostic imaging   drug therapy   MeSH
• Ultrasonography, Doppler MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial, Phase III MeSH
• Randomized Controlled Trial MeSH

Introduction: The plica is a residual septum that divides the knee into three compartments: supra, medial, and lateral. Although anatomically suprapatellar plica of the knee is common, it rarely causes symptoms. Thickening of suprapatellar plica may present as anterior knee pain with or without mechanical symptoms. The suprapatellar plica may be a cause to be missed as a cause to look for anterior knee pain. Case Presentation: 33-years-old woman presented with recurring anterior knee pain. A non-specific patellofemoral pain was concluded as initial diagnosis, but conservative treatment failed to relieve the pain. During exploratory arthroscopic examination, a shallow suprapatellar cavity with folded synovium with central perforation was found. Plica excision was done with no complication. After 10 days, the patient has significant improvement and after one month the patient walked uneventfully. Conclusion: Suprapatellar plica is the most common arthroscopic findings compared to other type of plica. Because the presence of suprapatellar plica does not always depict suprapatellar plica syndrome, it is a cause to be looked for during arthroscopy on anterior knee pain. The complete type of it, especially without perforation, appears only as shallow suprapatellar cavity, that the surgeon should be aware of.

• MeSH
• Arthroscopy methods   MeSH
• Adult MeSH
• Knee pathology   MeSH
• Humans MeSH
• Musculoskeletal Pain etiology   MeSH
• Treatment Failure MeSH
• Patella pathology   MeSH
• Patellofemoral Pain Syndrome * diagnosis   pathology   MeSH
• Synovitis * surgery   diagnostic imaging   physiopathology   pathology   therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Review MeSH

• MeSH
• Arthralgia diagnostic imaging   MeSH
• Early Diagnosis * MeSH
• Upper Extremity diagnostic imaging   MeSH
• Humans MeSH
• Magnetic Resonance Imaging * MeSH
• Osteitis diagnostic imaging   MeSH
• Predictive Value of Tests MeSH
• Disease Progression MeSH
• Arthritis, Rheumatoid * diagnostic imaging   MeSH
• Synovitis diagnostic imaging   MeSH
• Tenosynovitis diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

OBJECTIVE: To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA). METHODS: Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. RESULTS: Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively. CONCLUSION: Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.

• MeSH
• Delphi Technique MeSH
• Adult MeSH
• Incidence MeSH
• Consensus MeSH
• Middle Aged MeSH
• Humans MeSH
• Reproducibility of Results MeSH
• Arthritis, Rheumatoid pathology   MeSH
• Subtalar Joint diagnostic imaging   pathology   MeSH
• Synovitis diagnostic imaging   epidemiology   MeSH
• Ultrasonography, Doppler methods   standards   MeSH
• Research Design MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Evaluation Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Systematic Review MeSH

OBJECTIVE: To identify and synthesize the best available evidence on the application of musculoskeletal (MSK) ultrasound (US) in patients with systemic lupus erythematosus (SLE) and to present the measurement properties of US in different elementary lesions and pathologies. METHODS: A systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Original articles were included that were published in English between August 1, 2014, and December 31, 2018, reporting US, Doppler, synovitis, joint effusion, bone erosion, tenosynovitis, and enthesitis in patients with SLE. Data extraction focused on the definition and quantification of US-detected synovitis, joint effusion, bone erosion, tenosynovitis, enthesitis, and the measurement properties of US according to the OMERACT Filter 2.1 instruments selection. RESULTS: Of the 143 identified articles, 15 were included. Most articles were cross-sectional studies (14/15, 93%). The majority of the studies used the OMERACT definitions for ultrasonographic pathology. Regarding the measurement properties of US in different elementary lesions and pathologies, all studies dealt with face validity, content validity, and feasibility. Most studies achieved construct validity. Concerning the reliability of image reading, 1 study (1/15, 7%) assessed both intraobserver and interobserver reliability. For image acquisition, 4 studies (4/15, 27%) evaluated interobserver reliability and none had evaluated intraobserver reliability. Criterion validity was assessed in 1 study (1/15, 7%). Responsiveness was not considered in any of the studies. CONCLUSION: This literature review demonstrates the need for further research and validation work to define the involvement of US as an outcome measurement instrument for the MSK manifestations in patients with SLE.

• MeSH
• Adult MeSH
• Enthesopathy diagnostic imaging   MeSH
• Outcome Assessment, Health Care methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Musculoskeletal System diagnostic imaging   MeSH
• Cross-Sectional Studies MeSH
• Arthritis, Psoriatic diagnostic imaging   MeSH
• Reproducibility of Results MeSH
• Arthritis, Rheumatoid diagnostic imaging   MeSH
• Feasibility Studies MeSH
• Severity of Illness Index MeSH
• Synovitis diagnostic imaging   MeSH
• Lupus Erythematosus, Systemic diagnostic imaging   MeSH
• Tenosynovitis diagnostic imaging   MeSH
• Ultrasonography, Doppler methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Systematic Review MeSH