Objective:To explore the distribution variation of ultrasound-detected inflammatory lesions with clinical signs in patients with psoriatic arthritis (PsA).Methods:This was based on the Peking University First Hospital Psoriatic Arthritis (PKUPsA) cohort. Patients enrolled from January 2019 to June 2024 were inchuded, patients with complete data of physical examination and ultrasonographic evaluations of 62 joints in the hand and foot. The ultrasound-detected inflammatory lesions including synovitis, tenosynovitis, enthesitis, and soft tissue inflammation were compared with joint tenderness/swelling. The χ2 test was employed to analyze differences between groups. Results:A total of 7 440 joints in 120 PsA patients were included. Overall, the proportion of joints with clinical signs (tenderness or swelling) was higher than those with ultrasound-detected inflammatory lesions [9.14%(680/7 440) vs. 7.93%(590/7 440), χ2=1 245.928, P<0.001], with more tenderness joints than swelling joints [7.72%(574/7 440) vs. 6.14%(457/7 440), χ2=3 264.45, P<0.001]. Clinical signs were primarily observed in hand proximal interphalangeal (PIP), distal interphalangeal (DIP), wrist and ankle joints, mostly in DIP2 joints [19.58%(47/240)]. Ultrasound-detected inflammatory lesions were predominantly found in metatarsophalangeal (MTP), wrist, and ankle joints, mostly in MTP2 joints (18.75%, 45/240). Clinical signs were more prevalent than ultrasound-detected inflammatory lesions in hand PIP1-3, PIP5, DIP2, and DIP5 joints ( P<0.05), whereas more frequent ultrasound-detected inflammatory lesions than clinical tenderness/swelling were in MTP1-4 joints ( P<0.05). Among ultrasound-detected inflammatory lesions, synovitis in MTP2 joints (18.75%, 45/240), tenosynovitis in ankle joints (10.00%, 24/240), enthesitis in hand DIP2 joints (8.75%, 21/240), and soft tissue inflammation in MTP4 joints (2.50%, 6/240) most commonly observed. Dactylitis was more frequently observed in toes than in fingers, with the fourth toe most commonly affected(16.67%, 40/240). Ultrasound-detected inflammatory lesions were observed in 72.37%(55/240) of fingers/toes with clinical dactylitis, mainly presenting as synovitis, tenosynovitis, or combinations of these. Conclusion:PsA exhibits significant heterogeneity in the inflammatory lesions across different joints and lesion types. The discrepancies between clinical findings and ultrasonic inflammatory changes highlight the limitations of physical examination in fully capturing the pathological features of PsA. As a critical tool for PsA evaluation, ultrasonography offers distinct advantages in detecting subclinical inflammation and differentiating inflammatory from non-inflammatory lesions.

Objective:To explore the distribution variation of ultrasound-detected inflammatory lesions with clinical signs in patients with psoriatic arthritis (PsA).Methods:This was based on the Peking University First Hospital Psoriatic Arthritis (PKUPsA) cohort. Patients enrolled from January 2019 to June 2024 were inchuded, patients with complete data of physical examination and ultrasonographic evaluations of 62 joints in the hand and foot. The ultrasound-detected inflammatory lesions including synovitis, tenosynovitis, enthesitis, and soft tissue inflammation were compared with joint tenderness/swelling. The χ2 test was employed to analyze differences between groups. Results:A total of 7 440 joints in 120 PsA patients were included. Overall, the proportion of joints with clinical signs (tenderness or swelling) was higher than those with ultrasound-detected inflammatory lesions [9.14%(680/7 440) vs. 7.93%(590/7 440), χ2=1 245.928, P<0.001], with more tenderness joints than swelling joints [7.72%(574/7 440) vs. 6.14%(457/7 440), χ2=3 264.45, P<0.001]. Clinical signs were primarily observed in hand proximal interphalangeal (PIP), distal interphalangeal (DIP), wrist and ankle joints, mostly in DIP2 joints [19.58%(47/240)]. Ultrasound-detected inflammatory lesions were predominantly found in metatarsophalangeal (MTP), wrist, and ankle joints, mostly in MTP2 joints (18.75%, 45/240). Clinical signs were more prevalent than ultrasound-detected inflammatory lesions in hand PIP1-3, PIP5, DIP2, and DIP5 joints ( P<0.05), whereas more frequent ultrasound-detected inflammatory lesions than clinical tenderness/swelling were in MTP1-4 joints ( P<0.05). Among ultrasound-detected inflammatory lesions, synovitis in MTP2 joints (18.75%, 45/240), tenosynovitis in ankle joints (10.00%, 24/240), enthesitis in hand DIP2 joints (8.75%, 21/240), and soft tissue inflammation in MTP4 joints (2.50%, 6/240) most commonly observed. Dactylitis was more frequently observed in toes than in fingers, with the fourth toe most commonly affected(16.67%, 40/240). Ultrasound-detected inflammatory lesions were observed in 72.37%(55/240) of fingers/toes with clinical dactylitis, mainly presenting as synovitis, tenosynovitis, or combinations of these. Conclusion:PsA exhibits significant heterogeneity in the inflammatory lesions across different joints and lesion types. The discrepancies between clinical findings and ultrasonic inflammatory changes highlight the limitations of physical examination in fully capturing the pathological features of PsA. As a critical tool for PsA evaluation, ultrasonography offers distinct advantages in detecting subclinical inflammation and differentiating inflammatory from non-inflammatory lesions.

BACKGROUND: Vaccination has been shown effective in controlling the global coronavirus disease 2019 (COVID-19) pandemic and reducing severe cases. This study was to assess the flare and change in disease activity after COVID-19 vaccination in patients with stable rheumatoid arthritis (RA). METHODS: A prospective cohort of RA patients in remission or with low disease activity was divided into a vaccination group and a non-vaccination group based on their COVID-19 vaccination status. Each of them was examined every 3 to 6 months. In the vaccination group, disease activity was compared before and after vaccination. The rates of flare defined as disease activity scores based on 28-joint count (DAS28) >3.2 with ΔDAS28 ≥0.6 were compared between vaccination and non-vaccination groups. RESULTS: A total of 202 eligible RA patients were enrolled. Of these, 98 patients received no vaccine shot (non-vaccination group), and 104 patients received two doses of vaccine (vaccination group). The median time interval from pre-vaccination visit to the first immunization and from the second dose of vaccine to post-vaccination visit was 67 days and 83 days, respectively. The disease activity scores at pre-vaccination and post-vaccination visits in the vaccination group patients were similar. At enrollment, gender, RA disease course, seropositivity, and disease activity were comparable across the two groups. Flare was observed in five (4.8%) of the vaccination group patients and nine (9.2%) of the non-vaccination group patients at post-vaccination assessment ( P  = 0.221). In terms of safety, 29 (27.9%) patients experienced adverse events (AEs) after vaccination. No serious AEs occurred. CONCLUSIONS COVID-19 vaccinations had no significant effect on disease activity or risk of flare in RA patients in remission or with low disease activity. Patients with stable RA should be encouraged to receive the COVID-19 vaccination.
Humans ; Arthritis, Rheumatoid ; Cohort Studies ; COVID-19/prevention & control* ; COVID-19 Vaccines/adverse effects* ; East Asian People ; Prospective Studies ; Vaccination/adverse effects*

Objective:To investigate the frequency of metabolic syndrome (MS) in patients with psoriatic arthritis (PsA) and further analyze the correlation of MS and its components with clinical features of PsA.Methods:Data including demographics, clinical manifestations, laboratory tests, MS-associated features (height, weight, waist circumference, blood pressure, serum lipid spectrum, and so on) and history of complications (hypertension, diabetes mellitus, atherosclerosis, coronary heart disease, and cerebral vascular disease) were collected from PsA patients in our hospital from Jan 2017 to Sep 2019. The frequency of MS in PsA patients was calculated and the association between PsA clinical manifestations and MS as well as its components was investigated.Results:One hundred and sixty-two PsA patients who fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) were recruited. Hypertension was identified in 36 (22.2%) patients, diabetes mellitus in 28(17.2%) patients, coronary heart disease in 11(6.7%) patients, and cerebral vascular disease in 7 (4.3%) patients. Based on the criteria of the International Diabetes Federation (IDF), 58(35.8%) patients were diagnosed as MS. Compared with MS-free patients, patients with MS, hypertension or diabetes mellitus were older [(54±10 vs 44±13; 56±11 vs 45±12; 54±11 vs 44±13, respectively, t=5.058 , 4.450, 5.150, P<0.01 for all], with higher disease activity [DAPSA scores 16.75(11.25, 26.7) vs 8.8(4.8, 16.4), 16.3(9.6, 27.8) vs 10.0 (5.1, 18.0), 14.4 (9, 25.7) vs 9.5 (5, 17.7), Z=4.539 , 3.046, 3.063, P<0.01]. There was a positive correlation between the sum of components of MS and DAPSA score ( r=0.27 , P<0.01), but multiple linear regression showed no correlation between each component with DAPSA score ( P>0.05) except for hypertension ( P<0.01, standard coefficient=0.334) and elevated fasting blood glucose ( P=0.023, standard coefficient=0.247). PsA patients with hypertension had higher ESR [16.5 (9.5, 34.25) mm/1 h vs 10 (5, 24.5) mm/1 h, Z=2.127, P=0.012]. CRP level was higher in patients with dyslipidemia [5.6(2.1, 17.8) mg/L vs 3.7(1.5, 6.5) mg/L, Z=2.543, P<0.01]. Prevalence of inflammatory back pain was also higher in dyslipidemia patients (41.3% vs 22.4%, χ2=5.901, P=0.016). DAPSA score was higher in dyslipidemia patients (14.1 vs9.9, P=0.031). Conclusion:MS and its components are not rare comorbidities in PsA patients. PsA patients with MS tend to be older with higher disease activity, which calls for more attention.

Objective To investigate the features and discrepancies of the ultrasound findings of shoulders in patients with rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR).Methods Patients with RA and PMR who complained of pain,swelling or limited mobility of shoulder were enrolled for bilateral ultrasound assessment.Inflammatory lesions including long head biceps (LHB) tenosynovitis,subacromial-subdeltoid (SASD) bursitis,tendinosis of supraspinatus (SS) tendon effusion/synovitis in glenohumeral (GH) and acromioclavicular (AC) joints,as well as structural damages including SS tear,bone erosions and osteophytes on humeral head and AC joints were evaluated.Comparison of frequency of ultrasound features between the two groups was analyzed byx2 test.Results A total of 458 shoulders from 192 RA and 37 PMR patients were assessed by ultrasound.In RA patients,the most prevalent inflammatory findings were LHB tenosynovitis (31.3％),followed by SASD bursitis (25％),SS tendinosis (11.5％),AC and GH effusion/synovitis (10.4％ and 5.7％,respectively).LHB tenosynovitis was the most frequent finding in PMR patients (37.8％),followed by SS tendinosis (27％),SASD bursitis (24.3％),AC and GH effusion/synovitis (2.7％ and 0,respectively).Partial or complete tear of SS tendon was found in 9.9％ RA and 8.1％ PMR patients,respectively.SS tendinosis was more frequently presented in PMR than RA patients (x2=6.255,P＜0.05),while GH effusion/synovitis was more common in RA group (x2=3.983,P＜0.05).Bone erosions and osteophytes were common in both groups.SASD bursitis and SS tendinosis appeared to be more unilateral (77.1％ and 77.3％,respectively),while GH effusion/synovitis tended to be bilateral (63.6％) in RA patients.Conclusion Intra-articular inflammatory involvement (GH effusion/synovitis) is more frequent in RA,while peri-articular inflammatory involvement (SS tendinosis) is more frequent in patients with PMR.SASD bursitis and SS tendinosis appears to be unilateral,while GH effusion/synovitis tends to be bilateral in RA patients.

Objective To explore the risk factors of urate deposition on ultrasound in patients with gout.Methods All the gout patients who visited our center between February 2015 and February 2017 and underwent ultrasound examination of bilateral knees,ankles and first metatarsophalangeal joints (MTP1) were enrolled.Subgroup analysis was done depending on whether double contour sign (DCS) or tophus was found on ultrasound.Main statistical analysis methods were t test,chi-square test and logistic regression model.Results One hundred and twenty-six patients were included.DCS was found in 50(39.7％) patients and tophus was found in 48 (38.1％) patients.The serum uric acid (SU) level of the DCS positive group was signi-ficantly higher than the DCS negative group [(602±79) μmol/L vs (538±101) μmol/L,t=3.998,P=0.044].The hyperuicemia duration of the two groups were (186±87) months and (130±77) months,which was significantly different (t=3.330,P=0.002).The hyperuicemia duration of the tophus positive group was significantly higher than tophus negative group [(175±102) months vs (138±96) months,t=2.003,P=0.045].The SU level and hyperuicemia duration were independent risk factors of positive DCS in gout patients [OR =1.006,95％ CI (1.002,1.01 1);OR=1.028,95％CI (1.013,1.042)].The hyperuicemia duration was independent risk factor of positive tophus in gout patients [OR=1.004,95％CI (1.000,1.007)].Receiver operating characteristic curve (ROC) curve showed gout patient whose hyperuricemia duration was longer than 94months and SU level was higher than 505.5 μmol/L were more likely to have positive DCS in joints;meanwhile,patient whose hyperuricemia duration was longer than 137 months were more likely to have positive tophus in joints.Conclusion Gout patients who have positive DCS and tophus on ultrasound have longer hyperuicemia duration.Positive DCS is also related with patients' higher serum levels.The hyperuicemia duration is an independent risk factor of urate deposition on ultrasound in patients with gout.

Objective To explore the impact of dyslipidemia on uric acid stones by analyzing the relationship between blood lipids and urolithiasis in primary gouty patients.Methods We retrospectively identified patients with nephrolithiasis in primary gout patients who underwent stone chemical analysis,compared with gout patients without nephrolithiasis.The clinical parameters,urine analysis and lipid levels were analyzed.Patients were divided into groups based on serum lipid levels.The groups were compared based on demographic data and stone composition.Correlations were analyzed between serum lipid,urinary pH and uric acid stones.Moreover,the risk factors of uric acid stones were determined by logistic regression analysis.Analysis of variance,t-test,chi-square test,Spearman's test and Logistic regression were used for statistical analysis.Results ① A total of 144 gout patients were included in study,48 patients with urolithiasis and 96 patients without urolithiasis.② Serum lipid levels were significantly lower in urolithiasis group than those patients without urolithiasis including triglyceride (TG) [1.6(0.9,2.1) mmol/L vs 2.2(1.4,3.2) mmol/L,Z=2.38,P=0.01],total cholesterol (TC) [(4.4±1.2) mmol/L vs (5.1±1.0) mmol/L,t=5.3,P=0.006];low density lipoprotein cholesterol (LDL-C) [(2.5±0.9) mmol/L vs (3.2±0.9) mmol/L,t=4.2,P=0.005].③ Compared to oxalate stone formers,uric acid stone formers had significantly higher TG [(1.8±0.6) mmol/L vs (0.9±0.5) mmol/L,t=4.9,P=0.001),TC [(4.4±1.1) mmol/L vs (3.8±1.0) mmol/L,t=1.8,P=0.001] and LDL-C [(2.8±0.9) mmol/L vs (2.0±0.7) mmol/L,t=3.5,P=0.045],while the high density lipoprotein (HDL) level was lower [(0.94±0.23) mmol/L vs (1.32±0.41) mmol/L,t=-4.0,P=0.002].④ Percentage of uric acid stones in high TG group was higher than normal TG group [85％(17/20 vs 46.4％(13/28),x2=7.4,P=0.007],in addition,the percentage of uric acid stones in low HDL group was higher than normal HDL group [(82.1％(23/28) vs 35.0％(7/20),x2=11.1,P=0.001].⑤ Uric acid stones were significantly correlated with high TG,low LDL and urinary pH(r=0.522,0.47,-0.212,respectively).Logistic analysis showed risk factors for uric acid stone in primary gouty patients were high TG [OR=2.38,95％CI(1.41,13.7);P=0.01] and lower HDL level [OR=0.01,95％CI(0.01,0.43);P=0.01].Conclusion There is a link between dyslipidemia and kidney uric acid stone risk in primary gout patients.Specific alterations in patient's lipid profile may portend unique aberrations in urine physico-chemistry and uric acid stone risk.

Objective To evaluate the validity of assessing synovitis and tenosynovitis by using musculoskeletal ultrasound scoring systems after standardized training in Chinese doctors.Methods All participants received a 30 minutes' training for the ultrasound scoring systems of synovitis and tenosynovitis.Ten static images were applied to evaluate the changes before and after training,respectively.Each parameter was assessed by a four scale semi-quantitative system recommended by outcomes measures in rheumatoid arthritis clinical trials (OMERACT).Paired t-test was used to assess the differences before and after training.Results Thirteen rheumatologists and two ultrasonographers completed the entire procedure.Significant differences were found before and after training when assessing the severity of gray-scale of synovitis (0.61± 0.30 vs 0.45±0.23;t=2.230,P＜0.05) and power Doppler of synovitis (0.57±0.26 vs 0.31±0.18;t=2.928,P＜0.05) and tenosynotis (0.56±0.15 vs 0.31±0.16;t=5.286,P＜0.05),while no significant difference was found when assessing the gray scale of tenosynovitis (t=-1.679,P＞0.05).Conclusion Standardized training is helpful to improve the validity of ultrasound scoring systems of synovitis and tenosynovitis in Chinese rheumatologists and ultrasonographers.The validity of assessing gray-scale of tenosynovits needs improvement.

Objective To develop the optimal simplified combination of joints for ultrasonographic assessment of joint inflammation of wrists and hands in patients with rheumatoid arthritis (RA).Methods US examination was performed using grey-scale (GSUS) and power Dop.pler (PDUS) semi-quantitative scoring systems with scores 0-3 in 22 joints of 705 RA patients,including all proximal interphalangeal (PIP),metacarpophalangeal (MCP),and bilateral wrist joints.Continuous variables were presented as mean and standard deviation if normally distributed,and dichotomous variables were presented as frequencies.T test and Wilcoxon signed test were applied for statistical analysis.All correlations among US variables were assessed using Spearman's rank correlation test.Candidate joint set was selected by multiple stepwise linear regression analysis.Results Through multiple linear stepwise regression analysis,the standard coefficient of wrist,MCP5,MCP2 and MCP3 joints under GSUS was higher than other joints.And the adjusted R2 of the model composed of wrist,MCP5,MCP2 and MCP3 joints was greater than 0.9.Among the sum GS and PD scores of various selected joint combinations,total score-8 (GS vs PD),including bilateral wrist,MCP2,MCP3,MCP5 joints,not only showed highest sensitivity and negative predictive value (97.3 5％ vs 97.20％;92.67％ vs 97.21％,respectively),but also had the highest correlation with the total score-22 (GS,PD) (r=0.989,0.972,P＜0.01).Conclusion Total score-8,including bilateral wrist,MCP2,MCP3,MCP5 joints,is simple and efficient enough for monitoring active synovitis of wrists and hands in patients with RA in daily practice.