Rheumato

10 pages, 1493 KiB

Open AccessArticle

Diagnosis of Kawasaki Disease Presenting with Limited and Faint Principal Clinical Features

by Yuichi Nomura, Yuta Mikami, Kiminori Masuda, Yoshikazu Kato, Naho Nakazaki, Hiromi Ikeda, Masako Hirabayashi, Ryo Kusubae and Koji Sameshima

Rheumato 2022, 2(1), 24-33; https://doi.org/10.3390/rheumato2010004 - 1 Mar 2022

Cited by 1 | Viewed by 2168

Abstract

Background: We examined the characteristics of Kawasaki disease (KD) patients who presented with limited and faint principal clinical features. Methods: We retrospectively reviewed the clinical records of 62 KD patients who presented with limited and faint clinical features at admission. A clinical feature that was recognizable by even junior doctors was defined as a definite feature (d-Feature), and a feature that was faint and recognizable by only experienced doctors was defined as a faint feature (f-Feature). Results: At admission, 82% of patients presented with fever and ≤1 d-Feature. Two days later, the d-Features increased in number and diagnoses of KD were established in 32 patients with fever and ≥4 d-Features. In 30 patients with ≤3 d-Features, experienced doctors recognized f-Features and diagnosed KD in 22 patients because of fever and ≥4 features. Among eight patients with ≤3 features, experienced doctors diagnosed six patients as incomplete KD considering their faint abnormal echocardiographic findings. For the remaining two patients, experienced doctors decided to commence KD treatments considering the patients’ clinical course. Conclusions: Sufficient clinical experience is essential during the diagnosis of KD in patients presenting with limited and f-Features. Educational programs for junior doctors on how to recognize f-Features and evaluate faint abnormal coronary artery findings are necessary. Full article

(This article belongs to the Special Issue Feature Papers to Celebrate the Inaugural Issue of Rheumato)

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9 pages, 1217 KiB

Open AccessArticle

Angiotensin-Converting Enzyme Activity May Predict Disease Severity in Psoriasis

by Matilde Bandeira, Ângela Gil, Ana Carolina Santos, Vasco C. Romão, Mário Rui Mascarenhas, Paulo Filipe, João Eurico Fonseca and Manuel Bicho

Rheumato 2022, 2(1), 15-23; https://doi.org/10.3390/rheumato2010003 - 14 Feb 2022

Cited by 1 | Viewed by 2844

Abstract

Psoriasis is a multifactorial disease, with many genetic risk factors, one of which seems to be the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism. ACE activity has been shown to be higher in psoriatic patients and it suggests an oxidative stress state, as seen in many cardiovascular disorders. We aimed to explore the association between ACE activity and polymorphisms and cardiovascular risk amongst psoriatic patients. We included 64 psoriatic patients and 1091 controls and compared ACE I/D polymorphism genotype and serum activity for both groups. ACE genotypes were similar in psoriatic patients and controls. Notably, serum ACE activity was higher in psoriatic patients (19.09 ± 2.86 U/mL) compared to controls (11.85 ± 0.40 U/mL), p = 0.015. Non-HDL cholesterol was significantly lower in II polymorphism (p = 0.037). Psoriatic activity (PASI) was associated with a higher cardiovascular risk estimated by lower HDL concentrations (r = −0.496, p = 0.007), and higher triglyceride levels (r = 0.421, p = 0.020) and TC/HDL and LDL/HDL ratios (r = 0.612, p < 0.001 and r = 0.437, p = 0.023, respectively). Patients with psoriasis have higher ACE activity levels, independent of ACE genotype. Moreover, disease activity correlated with cardiovascular risk. This could support the eventual role of ACE as a possible biomarker for disease severity and cardiovascular risk in psoriasis patients. Full article

(This article belongs to the Special Issue Feature Papers to Celebrate the Inaugural Issue of Rheumato)

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13 pages, 2641 KiB

Open AccessArticle

Ultrasound Features across Subtypes of Juvenile Idiopathic Arthritis

by Doaa Mosad Mosa, Ashraf M. Abdelrahman and Amany S. El-Bahnasawy

Rheumato 2022, 2(1), 2-14; https://doi.org/10.3390/rheumato2010002 - 29 Jan 2022

Cited by 3 | Viewed by 2989

Abstract

Objective: The aim of this study was to evaluate musculoskeletal ultrasound (MSUS) features across categories of juvenile idiopathic arthritis (JIA). Methods: In this cross-sectional study, all patients were subjected to full history taking, clinical examination including disease assessment parameters and laboratory investigations. In addition, all children were examined by both grayscale (GS) and power Doppler (PD) MSUS images. Results: By MSUS, the number of joints with synovial effusion was 697 of a total 2400 examined joints (29%) and joints with synovial thickening counted 673 (28%). The number of joints with positive PD signals was 446 (18.6%). There was a significant difference among JIA subtypes as regards different MSUS features. Moreover, there was a discrepancy regarding synovial effusion (p = 0.018), hypertrophy scores (p = 0.013), and the total US severity score (p = 0.026). This divergence was attributed to the significant difference between systemic juvenile idiopathic arthritis (SJIA) and other categories. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MSUS in JIA and its subtypes were calculated. Conclusion: MSUS is a highly sensitive method for detecting synovitis, tenosynovitis, and erosive bone disease, and it helps to make proper therapeutic decisions. There was a significant difference among JIA subtypes regarding MSUS features. Full article

(This article belongs to the Special Issue Feature Papers to Celebrate the Inaugural Issue of Rheumato)

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