Relationship between arterial dysfunction and extra-articular features in patients with rheumatoid arthritis

Systemic inflammation may be a common process that underpins both atherosclerosis and extra-articular features (ExRA) of rheumatoid arthritis (RA). We evaluated the relationship between ExRA and arterial dysfunction in 114 consecutive patients with RA (82% women) without overt arterial disease aged 40–65?years. A trained research nurse undertook ‘SphygmoCor’ pulse wave analysis (PWA) using radial applanation tonometry to measure the extent (augmentation index, AIX%) and timing (reflected wave transit time, RWT, msec) of aortic wave reflection. Assessment included fasting blood sample, patient questionnaire and medical record review. Mean differences were adjusted for age, sex, mean blood pressure, smoking pack-years, fasting cholesterol, Stanford HAQ score and erythrocyte sedimentation rate. Mean age was 54 (SD 7) and median RA duration 10 (IQR 4–17) years. There was a trend for arterial dysfunction (higher AIX%; lower RWT) to increase as the number of ExRA features rose, but no difference in AIX% (?0.5, 95%CI ?2.8 to 1.8, P?=?0.65) or RWT (0.3?ms, 95%CI ?3.6 to 4.2, P?=?0.86) between ‘any ExRA’ and ‘no ExRA’. Arterial dysfunction was not associated with the presence of rheumatoid nodules, Sjogren’s syndrome or carpal tunnel syndrome. Our study was too small to determine whether severe (‘Malmo’) ExRA (vasculitis, pericarditis, episcleritis) was truly associated with a higher AIX% (3.8, 95%CI ?2.3 to 9.9, P?=?0.22) and lower RWT (?5.5?ms 95%CI ?13.1 to 2.1, P?=?0.16). While arterial dysfunction may be associated with the number of ExRA features and severe ExRA, it does not appear to be associated with other ExRA features.     

Conventional magnetic resonance imaging in confirmed progressive supranuclear palsy and multiple system atrophy

Conventional magnetic resonance imaging (cMRI) is often used to aid the diagnosis of progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), but its ability to predict the histopathological diagnosis has not been systematically studied. cMRI from 48 neuropathologically confirmed cases, including PSP (n = 22), MSA (n = 13), Parkinson's disease (PD) (n = 7), and corticobasal degeneration (n = 6), and controls (n = 9) were assessed blinded to clinical details and systematically rated for reported abnormalities. Clinical diagnosis and macroscopic postmortem findings were retrospectively assessed. Radiological assessment of MRI was correct in 16 of 22 (72.7%) PSP cases and 10 of 13 (76.9%) MSA cases with substantial interrater agreement (Cohen's kappa 0.708; P < .001); no PSP case was misclassified as MSA or vice versa. MRI was less sensitive but more specific than clinical diagnosis in PSP and both more sensitive and specific than clinical diagnosis in MSA. The “hummingbird” and “morning glory” signs were highly specific for PSP, and “the middle cerebellar peduncle sign” and “hot cross bun” for MSA, but sensitivity was lower (up to 68.4%) and characteristic findings may not be present even at autopsy. cMRI, clinical diagnosis, and macroscopic examination at postmortem have similar sensitivity and specificity in predicting a neuropathological diagnosis. We have validated specific radiological signs in pathologically confirmed PSP and MSA. However, the low sensitivity of these and macroscopic findings at autopsy suggest a need for imaging techniques sensitive to microstructural abnormalities without regional atrophy. © 2012 Movement Disorder Society     

About Your Child’s Eating (AYCE) scale psychometrics when applied to children in hospital-based feeding clinics

This study examined the About Your Child’s Eating scale (AYCE) when applied to a sample of children referred to hospital-based feeding clinics. The AYCE measures three dimensions of the family mealtime environment (Child Resistance to Eating, Positive Mealtime Environment, Parent/Caregiver Mealtime Aversion). Confirmatory factor analysis for AYCE subscales revealed close to acceptable goodness-of-fit values, strong internal reliability, and strong test-retest reliability. ANCOVAs examining AYCE subscales and child demographics found caregivers of younger and thinner children reported more Child Resistance to Eating and Caregiver Aversion to Mealtime, with other demographics not statistically significant.