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Title: Understanding and treating musculoskeletal systemic lupus erythematosus
Author: Mahmoud, Khaled I. Mustafa
ISNI:       0000 0004 7971 9666
Awarding Body: University of Leeds
Current Institution: University of Leeds
Date of Award: 2019
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Background: Musculoskeletal manifestations are common in Systemic lupus erythematosus. Most patients with inflammatory pain have no objective abnormality detectable by current clinical tools. Also, these tools may be poorly responsive. This is important because physicians need to decide when to start, increase or decrease immunosuppression for arthralgia. Imaging modalities such as ultrasound and magnetic resonance imaging have a promising role to solve these issues. Objectives: (1)define and quantify inflammatory musculoskeletal phenotypes in SLE; (2) to evaluate the accuracy and responsiveness of existing outcome measures; (3)determine whether patients with ultrasound-only synovitis are more responsive to therapy; (4) determine whether ultrasound is a more responsive outcome measure than the other tools; (5) to validate Ultrasound against MRI. Methods: (1) Consecutive SLE patients were evaluated clinically and by ultrasound synovitis; (2) a pilot longitudinal study was performed in 20 patients receiving glucocorticoids; (3) a definitive study (USEFUL) was performed in 133 patients to determine the responsiveness of ultrasound and other musculoskeletal variables, and predictive value of baseline ultrasound; (4) MRI scans were performed in 36 patients with varying degrees of clinical and US-synovitis. Results: (1) most patients with active musculoskeletal symptoms did not have clinical synovitis on examination and a large group of patients with subclinical synovitis found only using ultrasound was associated with worse symptoms and serology; (2) clinical instruments underestimated ultrasound-confirmed response to therapy; (3) the USEFUL study showed that patients with baseline ultrasound synovitis had better responses to therapy as long as fibromyalgia was excluded. Ultrasound remained highly responsive, with varying degrees of responses in clinical instruments, but this did not correlate with patient-reported improvement; (4) MRI synovitis was confirmed in patients with ultrasound-only synovitis. Conclusion: Ultrasound provides an accurate objective measure of synovitis in lupus patients and could be used to improve patient care and clinical trials.
Supervisor: Emery, Paul ; Vital, Edward ; Zayat, Ahmed Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available