Objective. To determine the efficacy of IA corticosteroid (CS) injection in pain reduction for hip OA under ultrasound (US) guidance. Methods. Forty patients [mean age 62.78 (8.16) years] fulfilling ACR criteria for hip OA, with synovitis detected at US, gave their consent for IA US-guided CS injection because of pain refractory to conventional therapy. At baseline, at 1 and 3 months, patients filled up a visual analogue scale (VAS) pain on walking, performed the Lequesne index and were checked by US for synovitis. Results were compared with age-matched controls. The occurrence of side effects both short and long term was monitored. Results. IA steroid deposition was performed under US guidance. After 1 and 3 months, walking pain VAS was significantly reduced vs baseline (P < 0.001) and had high correlation with Lequesne index. Synovial hypertrophy was reduced in 75% of the hips after 1 and 3 months vs baseline (P < 0.001). In the group of controls, hip walking pain VAS, Lequesne index and synovial hypertrophy were not changed at 3 months vs baseline (P > 0.05). Transient facial rash was present in 16 patients during the first 24–48 h after injection. No side effects were reported. Conclusion. US-guided steroid injections in hip OA is an efficacious and safe therapeutic approach to achieve pain control and reduction of synovial hypertrophy avoiding the use of X-ray-guided procedure.

Objective: Administration of nonsteroidal antiinflammatory drugs (NSAIDs) may impair fertility. The occurrence of the luteinized unruptured follicle (LUF) syndrome was assessed in women with inflammatory arthropathies exposed to NSAIDs and compared to that in nonexposed women.Methods: Fourteen patients with inflammatory rheumatic disease, 29 women with noninflammatory musculoskeletal conditions, and 449 women not exposed to NSAIDs were studied by intravaginal ultrasound monitoring for follicular development and ovulation in 1 or more menstrual cycles. Disease activity was assessed in inflammatory rheumatic disease.Results: In 59 monitored cycles of patients with continuous NSAID exposure, 35.6% of LUF syndromes occurred compared to 3.4% of LUF syndromes in untreated women (P < 0.001). Etoricoxib was responsible for 75% of LUF syndromes in patients exposed continuously, whereas diclofenac generated 15% of LUF syndromes. An ibuprofen dosage of 1,600 mg/day did not induce LUF syndrome either at continuous periovulatory or discontinuous exposure. Interestingly, the frequency of LUF syndrome was 46.2% in patients with inactive inflammatory disease compared to 15% in patients with active disease (P = 0.023). Etoricoxib generated LUF syndrome in 94.2% of the cases with inactive disease versus 28.6% in patients with active disease (P = 0.003).Conclusion: NSAIDs increased the risk of the LUF syndrome, particularly in patients with inactive disease. The selective cyclooxygenase 2 (COX‐2) inhibitor etoricoxib was a more potent inductor of LUF syndrome than nonselective COX inhibitors. Continuous periovulatory exposure to NSAIDs should be avoided when planning a pregnancy in patients with rheumatic diseases.

Objective. The aim of this study was to study the influence of active disease status and TNF-α antagonists on sperm quality in a group of AS patients. Methods. Twenty-three active AS patients and 42 controls were recruited. Patients’ sperm samples were analysed at baseline (previous to) and at 3–6 months after TNF-α therapy (adalimumab, infliximab, etanercept) administration. Baseline assessment was made for only 20 patients, 2 of them proving to have normal fertility, 2 having a pregnant stable partner and the third having a 9-month-old child. Six patients were retested after 12 months of biologic therapy. Each patient acted as his own comparator. Results were further compared with sperm samples from age-matched controls. Sperm analysis was performed according to the World Health Organization (WHO) 1999 guidelines. Results. Patients’ baseline assessment showed normozoospermia in 91% and oligozoospermia in 9% of patients. No significant differences in sperm quality were noticed at follow-up visits compared with baseline. Comparison to controls showed no statistically significant differences in semen quality, with some exceptions: the control group presented a higher percentage of non-progressive and immobile sperm cells and higher numbers of head and tail atypias. Conclusion. Sperm quality in patients with active AS and after receiving short- and long-term TNF-α blocker therapy is comparable to sperm quality in healthy controls. Our study confirms that the disease process of AS does not have a major impact on sperm quality and that treatment with anti-TNF has no negative impact on sperm quality even under long-term treatment.

Objective. To assess inter-observer reliability in US detection of tendon inflammatory and structural changes at wrists and ankles in RA patients. Methods. Fourteen consecutive RA patients underwent bilateral US assessment of the extensor carpi ulnaris (ECUT) and tibialis posterior tendons (TPTs) by two blinded rheumatologists, with different level of experience in musculoskeletal (MS) US. Grey scale and power Doppler (PD) US assessment was focused on detection of tenosynovitis, tenosynovial and intra-tendon PD signal and structural lesions (i.e. tendinosis, tendon erosion, partial or total rupture). Results. The frequency of US findings detected by Investigator 1 was 28.6% for inflammatory changes and 51.8% for structural damage changes while Investigator 2 detected 34 and 53.6% for the corresponding abnormalities. A high overall agreement (82.7%) was found for inflammatory pathology and 89.7% for structural lesions in all tendons. Mean kappa (κ) values for all tendons and pathology was moderate (κ = 0.42), with fair level of agreement for the wrist region (0.27–0.34) and moderate to good values for the ankle region (κ = 0.47–0.62). Subclinical abnormalities were detected in 37.5% of the tendons by Investigator 1 and 28.6% of the tendons by Investigator 2. Conclusions. MSUS showed high overall agreement and fair to moderate inter-observer κ-values between investigators with different levels of experience in detection of tendon pathology at the wrist and ankle in RA patients. Further standardization of scanning method and pathology definitions may improve MSUS reproducibility.