Dr. Ziad Farah

Cutaneous Polyarteritis Nodosa Presenting Atypically with Severe Pharyngeal Ulceration

Polyarteritis nodosa (PAN) is a multisystem, necrotising vasculitis of small- and medium-sized arteries with a predilection for the visceral vessels. Cutaneous PAN is a rare variant with symptomatic vasculitis limited to the skin ...

Flares of rheumatoid arthritis following coronavirus vaccination

AbstractBackground/Aims. With the emergence of the coronavirus vaccine and the clear and important role it provides in maintaining the health of individual

A SIMPLE CLINICAL SCORING TOOL CAN BE USED TO IMPROVE PATIENT SELECTION FOR ULTRASOUND IN DIAGNOSING EARLY INFLAMMATORY ARTHRITIS

Background Ultrasonography has been shown to be more sensitive than clinical examination in detecting clinical/subclinical synovitis and improving diagnostic certainty in early inflammatory arthritis (EIA). Local audit suggests increasing demand on ultrasound clinics to aid diagnosis in patients with suspected EIA therefore increasing waiting times. There is limited research to identify the patients most likely to benefit from an early ultrasound. Objectives Methods We conducted a retrospective analysis of the electronic records of patients attending the rheumatology-led musculoskeletal ultrasound clinic for a diagnostic scan between January and September 2017. Data on pre-test diagnosis, ultrasound findings and post-scan diagnosis was obtained. Clinical data was used to devise a scoring tool to predict variation in pre and post-scan diagnosis. Prospective data was then collected to confirm the validity of this scoring tool. Results 200 patient records were reviewed. In 102 patients (51%), the post ultrasound scan diagnosis differed from the pre-scan diagnosis. Patients referred with polyarthralgia of uncertain cause (n=92) were the largest group in whom the post-scan diagnosis differed (64, 69.6%) as the scan was able to identify a diagnosis. Patients with a pre-scan diagnosis of osteoarthritis or fibromyalgia (n=48) were more likely to have no difference in post-scan diagnosis (40, 83.3%). We generated a score for each patient with one point given to: duration(>6 weeks), (any)tender joints, (any)swollen joints, rheumatoid factor positive, anti-citrulinated protein antibody positive, C-reactive protein(>5mg/L), erythrocyte sedimentation(>age adjusted value), early morning stiffness(>30 minutes), or radiographic erosions. 39 patients scored 0–1, and 4 patients scored 7–9. In none of these categories did the ultrasound alter the diagnosis. Among patients with a score 2–6, the ultrasound altered overall diagnosis in 26% (n=157). Scores 5 and 6 demonstrated most variation between pre and post-scan diagnoses (45%). We applied the score set prospectively and preliminary data indicates a similar distribution of results (data collection in progress). Conclusion References [1] Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 2005;64(3):375-81 [2] Wakefield RJ, Green MJ, Marzo-Ortega H, Conaghan PG, Gibbon WW, McGonagle D, et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 2004;63(4):382-5. Disclosure of Interests None declared