BSAVA Formulary: Your questions answered

A new edition of the BSAVA Small Animal Formulary has been published. Ian Ramsey explains what is in and what is out of this new version

The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population

Background: To update community-based prevalence values for Polymyalgia Rheumatic (PMR) and Giant Cell Arteritis (GCA) using case record review supplemented by population survey and subsequent clinical review. Methods: Clinical data were obtained from case records of a large primary care practice in Norfolk, UK and reviewed for diagnoses of GCA and PMR. In addition postal survey was carried out to capture potentially undiagnosed cases within the practice population. Those screening positive for potential diagnoses of GCA and PMR were invited for clinical review. A cumulative prevalence estimate was subsequently calculated on those diagnosed within the GP practice and subsequently on those fulfilling the various published classification criteria sets. The date of the database lock and mail merge was March 2013. Results: Through detailed systematic review of 5,159 GP case records, 21 patients had a recorded diagnosis of GCA and 117 had PMR . No new cases were identified among 2,227 completed questionnaires returned from the population survey of a sample of 4,728. The resulting cumulative prevalence estimate in those aged ≥55 years meeting the ACR classification criteria set for GCA was 0.25% (95% CI 0.11% to 0.39%) and for five published criteria sets for PMR ranged from 0.91% to 1.53% (95% CI ranges 0.65%, 1.87%). The prevalence of both conditions was higher in women than in men and in older age groups. Conclusion: This study provides the first UK prevalence estimate of GCA and PMR in over 30 years and is the first to apply classification criteria sets

Charakterisierung eines neuen monoklonalen Antikörpers gegen den humanen Somatostatin-Rezeptor 5

Die Überexpression von Somatostatin-Rezeptoren in vielen Tumoren macht diese zu einem molekularen Ziel von zunehmender Bedeutung in der Tumordiagnostik und -therapie. Das Ziel der vorliegenden Arbeit war die ausführliche Charakterisierung des neuen monoklonalen Anti-SSTR5-Antikörpers UMB4 30-5. Zur Analyse der Sensitivität und Spezifität des Antikörpers wurden immunzytochemische Untersuchungen an stabil transfizierten Zellen, Western-Blot-Analysen, Präabsorptionskontrollen und immunhistochemische Färbungen mit dem UMB4 30-5 durchgeführt. Im Weiteren wurde parallel der monoklonale Anti-SSTR2-Antikörper UMB1 97-1 in den Analysen eingesetzt, um die Expression des SSTR5 mit dem Expressionsmuster des SSTR2 in normalen und neoplastischen humanen Geweben zu vergleichen. Insgesamt konnte in der vorliegenden Arbeit gezeigt werden, dass sich der neu entwickelte monoklonale Antikörper UMB4 30-5 aufgrund seiner hohen Spezifität sowohl für den Nachweis des SSTR5 aus nativen Geweben im Western-Blot als auch für dessen Detektion in Paraffinschnitten humaner Gewebe eignet. Er ermöglicht somit in Zukunft die Erforschung der SSTR5-Signalwege und ihrer Regulation und stellt ein wertvolles Werkzeug für die Routine-Diagnostik zur Erfassung des SSTR5-Rezeptorstatus dar

Frecuencia de trastornos Temporomandibulares en mujeres en etapa de climaterio de la Clínica San Juan de Dios Arequipa 2017

El presente estudio es de tipo no experimental, prospectivo, transversal y descriptivo. Tuvo como objetivo determinar la frecuencia con la que se presentan los trastornos temporomandibulares en mujeres climatéricas. La muestra estuvo conformada por 50 mujeres de la Clínica San Juan de Dios Arequipa que reunieron los criterios de inclusión. A cada paciente se le realizó un examen clínico (para determinar el uso de prótesis) y se aplicó el Índice de Helkimo para evaluar los TTM, obteniendo los siguientes signos frecuentes: limitación leve en apertura máxima bucal (entre 30 a 39 mm) en un 58%; limitación leve en lateralidad derecha máxima (de 4 a 6 mm) en un 64%; limitación leve en lateralidad izquierda máxima (de 4 a 6 mm) en un 46%; limitación severa del movimiento protrusivo (de 0 a 3 mm) en 50%; limitación en el movimiento mandibular (deterioro severo) en un 72%; función de la ATM (presencia de ruidos articulares o desviación mayor a 2 mm en apertura y cierre) en un 62%. Los síntomas frecuentes fueron: en cuanto al estado muscular, presentaron sensibilidad a la palpación muscular hasta en 3 áreas un 40% de mujeres; en cuanto al estado de la ATM, un 56% presentaron sensibilidad a la palpación periauricular y/o posterior de la ATM; y el 48% de mujeres climatéricas refieren dolor al movimiento mandibular. Se obtuvo que el 94% de mujeres climatéricas presentaron algún indicio de trastorno temporomandibular de acuerdo al Índice de Helkimo. La frecuencia de los trastornos temporomandibulares de acuerdo al grado de severidad según Índice de Helkimo fue: trastorno temporomandibular moderado en un 38% de pacientes. La frecuencia de trastornos temporomandibulares en mujeres climatéricas según edad fue de 16% de mujeres menores de 50 años que presentaron en su mayoría TTM moderado. La frecuencia de trastornos temporomandibulares de acuerdo a si usa o no algún tipo de prótesis fue que el 24 % de pacientes que son portadores de prótesis presentan en su mayoría TTM moderado. En cuanto a la frecuencia de trastornos temporomandibulares según etapa de climaterio en la que se encuentren se obtuvo que 44% de pacientes que están en climaterio perimenopáusico presentaron en su mayoría TTM, siendo el TTM moderado (20%) el más frecuente. La frecuencia de trastornos temporomandibulares en mujeres climatéricas según la triada sintomatológica de los TTM es del 74%. Por otro lado, el 26% de mujeres climatéricas no presentaron TTM

Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis

Background Giant cell arteritis (GCA), if untreated, can lead to blindness and stroke. The study’s objectives were to (1) determine a new evidence-based benchmark of the extent of diagnostic delay for GCA and (2) examine the role of GCA-specific characteristics on diagnostic delay. Methods Medical literature databases were searched from inception to November 2015. Articles were included if reporting a time-period of diagnostic delay between onset of GCA symptoms and diagnosis. Two reviewers assessed the quality of the final articles and extracted data from these. Random-effects meta-analysis was used to pool the mean time-period (95% confidence interval (CI)) between GCA symptom onset and diagnosis, and the delay observed for GCA-specific characteristics. Heterogeneity was assessed by I 2 and by 95% prediction interval (PI). Results Of 4128 articles initially identified, 16 provided data for meta-analysis. Mean diagnostic delay was 9.0 weeks (95% CI, 6.5 to 11.4) between symptom onset and GCA diagnosis (I 2 = 96.0%; P < 0.001; 95% PI, 0 to 19.2 weeks). Patients with a cranial presentation of GCA received a diagnosis after 7.7 (95% CI, 2.7 to 12.8) weeks (I 2 = 98.4%; P < 0.001; 95% PI, 0 to 27.6 weeks) and those with non-cranial GCA after 17.6 (95% CI, 9.7 to 25.5) weeks (I 2 = 96.6%; P < 0.001; 95% PI, 0 to 46.1 weeks). Conclusions The mean delay from symptom onset to GCA diagnosis was 9 weeks, or longer when cranial symptoms were absent. Our research provides an evidence-based benchmark for diagnostic delay of GCA and supports the need for improved public awareness and fast-track diagnostic pathways

Temporal arteritis presenting as a symmetrical polyarthritis

An 83 year old women presenting with a symetrical peripheral polyarthritis resembling rheumatoid arthritis subsequently developed biopsy-proven temporal arteritis

New insights into the pathogenesis of giant cell arteritis

Giant cell arteritis (GCA) is an inflammatory chronic disease occurring exclusively in elderly individuals. Until recently, the disease has been considered a unique disease resulting from the interaction in the walls of susceptible arteries, between an unknown infectious agents with local dendritic cells (DCs), activated CD4 T cells and effector macrophages. Recent evidence has shown that this view was too simplistic and has clarified many of the pathogenetic aspects of the disease. Many genetic studies recently published have identified different new genes, including cytokines, adhesion molecules and regulators of innate immunity, as crucial players in the development and progression of GCA. Recent evidence suggests that there is heterogeneity of histological lesions in GCA, that are correlated with different immunological Th9 and Th17 signature. The recent demonstration that Varicella-zoster virus (VZV) antigen is present in the 64% of GCA-negative TAs and in the 73% of GCA-positive TAs could represent an important point of arrival in the search for a causative agent in the pathogenesis of a metameric disease such as GCA. In this context, cytokines such as IL-32 and IL-33 that act as a danger signal following tissue damage and infection are over-expressed in GCA arteries. Artery tertiary lymphoid organs, present in up to 50% of GCA-positive arteries, could represent the sites were primary immune responses and T- and B-cell autoimmune responses against viral antigens are organized. The recently demonstrated disturbed distribution of B cells in GCA could be also relevant in the pathogenesis of the disease, possibly contributing to the enhanced IL-6 response. Altogether, these evidences may clarify many pathogenetic aspect of the disease, also suggesting complexity greater than first imagined