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    Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: a cluster analysis in the worldwide ASAS-PerSpA study
    (2021)
    Clementina López-Medina
    ;
    Sylvie Chevret
    ;
    Anna Molto
    ;
    Joachim Sieper
    ;
    Tuncay Duruöz
    <jats:sec><jats:title>Objective</jats:title><jats:p>To identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Cross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist‘s diagnosis as well as with the classification criteria was found.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.</jats:p></jats:sec>
      6Scopus© Citations 18
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      23  1Scopus© Citations 23
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    Soleus muscle and Achilles tendon compressive stiffness is related to knee and ankle positioning
    (2022)
    Carlos Cruz-Montecinos
    ;
    BESOMI MOLINA, MANUELA  
    ;
    Nicolás Acevedo-Valenzuela
    ;
    Kevin Cares-Marambio
    ;
    Alejandro Bustamante
      3Scopus© Citations 10
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      12Scopus© Citations 3
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      1  2Scopus© Citations 4
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    Mini-Open Achilles Tendon Rupture Repair
    (2019)
    EMILIO WAGNER HITSCHFFELD
    ;
    Pablo Wagner  
      5Scopus© Citations 6
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    Proximal and Distal Failure Site Analysis in Percutaneous Achilles Tendon Rupture Repair
    (2019)
    WAGNER HITSCHFELD, PABLO  
    ;
    Mario López
    ;
    WAGNER, EMILIO  
    ;
    Gastón Etchevers
    ;
    Oscar Valencia
    <jats:sec><jats:title>Background:</jats:title><jats:p> Different techniques have been described for percutaneous Achilles tendon rupture repair, but no biomechanical evaluation has been performed separately for proximal and distal suturing techniques. The purpose of this study was to biomechanically analyze proximal versus distal percutaneous Achilles suture configurations during cyclic loading and load to failure. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A simulated, midsubstance rupture was created 6 cm proximal to the calcaneal insertion in fresh-frozen cadaveric Achilles tendons. Fifteen proximal specimens were divided into 3 groups: (A1) triple locking technique, (A2) Bunnell-type technique, and (A3) double Bunnell-type technique. Twelve distal specimens were divided into 2 groups: (B1) triple nonlocking technique and (B2) oblique technique. Repairs were subjected to cyclic testing and load to failure. Load to failure, cause of failure, and tendon elongation were evaluated. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> None of the proximal specimens and 7/12 of the distal ones failed in cyclic testing. The proximal fixation groups demonstrated significantly more strength than the distal groups ( P = .001), achieving up to 710 N of failure load in Group A3. Groups B1and B2 failed on average at 380 N with no difference between them ( P &gt; .05). The majority of all repairs failed in the suture-tendon interface. Distal groups had more elongation during cyclic testing (13.7 mm) than proximal groups (9.4 mm) ( P = .02). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The distal fixation site in this Achilles tendon repair was significantly weaker than the proximal fixation site. A proximal modified suture configuration increased resistance to cyclic loading and load to failure significantly. </jats:p></jats:sec><jats:sec><jats:title>Clinical Relevance:</jats:title><jats:p> A modification can be suggested to improve strength of the Achilles repair. </jats:p></jats:sec>
      34  1Scopus© Citations 15