Rheumatology Round-up: Six-Year Outcomes of ACL Revision Surgery; and More

RA Predictors ID’d in Undifferentiated Large Joint Arthritis

Autoantibody positivity and subclinical synovitis are independent predictors of rheumatoid arthritis (RA) among patients presenting with undifferentiated large joint arthritis, according to a study published online in Rheumatology. A total of 221 consecutive patients with new-onset, undifferentiated large joint arthritis were followed; 45 had magnetic resonance imaging (MRI) of the hand and foot. Patients mainly presented with knee or ankle monoarthritis. The researchers found that 17 percent of patients developed RA during the 12 months of follow-up. “These findings demonstrate the increasing utility and importance of MRI in research and clinical practice,” the authors write. “Further work is required to design clinical algorithms in which there will be a cost-benefit ratio of using high resolution imaging.”

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Inflammation at IP Thumb Joint Common in Psoriatic Arthritis

Patients with psoriatic arthritis (PsA) more often have inflammation at the interphalangeal (IP) joint of the thumb compared to those with undifferentiated inflammatory arthritis (UIA), according to a study. In multivariable analysis, autoantibody-positivity (anticitrullinated protein antibodies and/or rheumatoid factor) and MRI-detected synovitis in hands and feet were independently associated with RA-development (odds ratios, 10.29 and 7.88, respectively). “These findings demonstrate the increasing utility and importance of MRI in research and clinical practice,” the authors write. “Further work is required to design clinical algorithms in which there will be a cost-benefit ratio of using high resolution imaging.”

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Factors ID’d for Six-Year Outcomes of ACL Revision Surgery

Surgical variables at the time of revision anterior cruciate ligament (ACL) reconstruction influence patient outcomes at six years, according to a study presented at the combined annual meeting of the American Orthopedic Society for Sports Medicine and the Arthroscopy Association of North America, held from July 7 to 11 in Nashville, Tennessee. Rick Wright, MD, from the Vanderbilt University Medical Center in Nashville, and colleagues followed revision ACL reconstruction patients for six years to examine whether surgical factors influence outcome. A total of 1,234 patients were enrolled; follow-up was obtained on 77 percent of patients at six years. The researchers found that several surgical factors were significant drivers of poorer outcomes at six years, with the most consistent surgical variables driving outcomes related to femoral and tibial fixation. “Opting for a transtibial surgical approach and choosing an [interference] screw for femoral and tibial fixation, will improve the patient’s odds of having a significantly better six-year clinical outcome,” Wright said in a statement.

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Meniscal Implant May Ease Post-Partial Meniscectomy Pain

Patients receiving a meniscus implant as part of a Sports Medicine Care program rather than nonsurgical care may experience greater relief from persistent or recurrent pain following arthroscopic partial meniscectomy, according to a study presented at the combined annual meeting of the American Orthopedic Society for Sports Medicine and Arthroscopy Association of North America. The researchers found that for five of six Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, the magnitude of improvement from baseline to two years was significantly greater in the implant group, including in the primary outcomes of KOOS Overall and KOOS Pain. “Overall, the implant group experienced superior improvements and outcomes at two years compared to subjects receiving nonsurgical care alone,” a coauthor said in a statement.