RESUMO
To describe the prevalence and distribution of clinical and ultrasound (US) pathological findings at ankle level and to compare them, in patients with rheumatoid arthritis (RA). This is a descriptive, cross-sectional study assessing patients diagnosed with RA according to the 2010 ACR criteria, who were recruited consecutively and independently of disease status or treatment and of the presence of pain at ankle level. Clinical and US findings were acquired by two independent rheumatologists. US assessments were performed according to the EULAR and OMERACT indications. A total of 224 ankles of 112 RA patients were examined. One hundred (89.3%) patients were women and 12 (10.7%) were men, with a mean age of 51 years. RA mean disease duration was 72 months. Ankle spontaneous pain was found in 56.2% of the patients. In 65.2% of the patients, US found at least one pathologic sign indicative of joint and/or tendon pathology. Using grayscale US, joint involvement was more frequently found than tendon pathology (37.5% vs 22.3%). Conversely, no substantial difference was found between the prevalence of power Doppler signal at joint and tendon level. There was a significant correlation between clinical findings and US findings indicative of tibiotalar joint synovitis and peroneal tenosynovitis. In the present study, pain and US pathologic findings at ankle level were described and compared in a cohort of RA patients. Spontaneous pain was found in more than half of the patients and US found joint involvement more prevalent than tendon pathology.
Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Dor/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prevalência , Reumatologia , Sinovite/diagnóstico por imagem , Sinovite/fisiopatologia , Tendões/diagnóstico por imagem , Tenossinovite/complicações , Ultrassonografia Doppler , Adulto JovemRESUMO
Objetivo: Evaluar ecográficamente el carpo y su quinto y sexto compartimento extensor en pacientes con artritis reumatoidea (AR), correlacionando los hallazgos con la presencia del signo clínico de la tecla de piano. Métodos: Se incluyeron pacientes con diagnóstico de AR que acudieron a la consulta ambulatoria entre enero y junio de 2009. Se recolectaron datos sociodemográficos, clínicos, y parámetros de actividad de la enfermedad. Se realizó examen físico a cargo de un evaluador, quien constataba la presencia del signo de la tecla. Las evaluaciones ecográficas fueron realizadas en forma ciega por un único médico el mismo día de la consulta, evaluando la presenciade sinovitis a nivel de carpo y el compromiso del quinto y sexto compartimento extensor. Resultados: Se incluyeron 34 pacientes, el 80% eran de sexo femenino y la mediana de edad fue de 56 años (RIQ: 30-84). La mediana de tiempo de evolución de la artritis fue de 114 meses (RIQ: 14-540). Se evaluaron 68 carpos observándose clínicamente la presencia de tecla cubital positiva en el 36,7%. En los carpos con signo de la tecla positivo se observó sinovitis en un 96% y en los que tenían signo de la tecla negativo, 83,7%. A nivel del sexto compartimento se evidenció tendinosis en un 16% de los pacientes con tecla positiva vs. 28% en los de tecla negativa, y tenosinovitis en un 28% vs. 14%, respectivamente. Conclusiones: Este es el primer estudio en nuestro país en correlacionar la presencia del signo de la tecla y los hallazgos ecográficosdel carpo y su quinto y sexto compartimento extensor. Los datos recolectados nos hacen suponer que no existe asociación entre la presencia del signo clínico evaluado y las manifestaciones ecográficas.
Objective: To evaluate the wrist and his fifth and sixth extensor compartments in patients with rheumatoid arthritis (RA) using ultrasound (US) and compared the findings with the piano key sign.Methods: Consecutive adult patients with RA who attended the outpatient clinic at the rheumatology section of our center from January to June 2009 were included. We recorded socio-demographic, clinical and disease activity data. A rheumatologist carried out a physical examination to evaluate the presence of the piano key sign.US assessment was performed by a single rheumatologist the same day and evaluates the presence of wrists synovitis and fifth and sixth extensor compartment damage. Results: 34 patients were included, 80% female, median age 56 years (IQR: 30-84). The median disease duration was 114 months (IQR: 14-540). 68 wrists were evaluated. The piano key sign wasobserved in 36.7%. In wrists with the piano key sign, US synovitis was observed in 96% and at the wrists without the sign we observedsynovitis in 83.7%. At the sixth compartment, we observed tendinosis in 16% of the patient who had the piano key sign vs. 28% without the sign, and tenosynovitis in 28% vs. 14, respectively. Conclusions: This study is the first in our country to compare thepresence of the piano key sign with the ultrasonographic findings in de wrist and his fifth and sixth extensor compartment. The data collected enables us to suppose that there is no association between the presence of the clinical sign and the ultrasonographicfindings.
Assuntos
Artrite Reumatoide , UltrassonografiaRESUMO
Objetivo: Evaluar ecográficamente el carpo y su quinto y sexto compartimento extensor en pacientes con artritis reumatoidea (AR), correlacionando los hallazgos con la presencia del signo clínico de la ¶tecla de piano÷. Métodos: Se incluyeron pacientes con diagnóstico de AR que acudieron a la consulta ambulatoria entre enero y junio de 2009. Se recolectaron datos sociodemográficos, clínicos, y parámetros de actividad de la enfermedad. Se realizó examen físico a cargo de un evaluador, quien constataba la presencia del signo de la tecla. Las evaluaciones ecográficas fueron realizadas en forma ciega por un único médico el mismo día de la consulta, evaluando la presenciade sinovitis a nivel de carpo y el compromiso del quinto y sexto compartimento extensor. Resultados: Se incluyeron 34 pacientes, el 80% eran de sexo femenino y la mediana de edad fue de 56 años (RIQ: 30-84). La mediana de tiempo de evolución de la artritis fue de 114 meses (RIQ: 14-540). Se evaluaron 68 carpos observándose clínicamente la presencia de tecla cubital positiva en el 36,7%. En los carpos con signo de la tecla positivo se observó sinovitis en un 96% y en los que tenían signo de la tecla negativo, 83,7%. A nivel del sexto compartimento se evidenció tendinosis en un 16% de los pacientes con tecla positiva vs. 28% en los de tecla negativa, y tenosinovitis en un 28% vs. 14%, respectivamente. Conclusiones: Este es el primer estudio en nuestro país en correlacionar la presencia del signo de la tecla y los hallazgos ecográficosdel carpo y su quinto y sexto compartimento extensor. Los datos recolectados nos hacen suponer que no existe asociación entre la presencia del signo clínico evaluado y las manifestaciones ecográficas.(AU)
Objective: To evaluate the wrist and his fifth and sixth extensor compartments in patients with rheumatoid arthritis (RA) using ultrasound (US) and compared the findings with the ¶piano key sign÷.Methods: Consecutive adult patients with RA who attended the outpatient clinic at the rheumatology section of our center from January to June 2009 were included. We recorded socio-demographic, clinical and disease activity data. A rheumatologist carried out a physical examination to evaluate the presence of the ¶piano key sign÷.US assessment was performed by a single rheumatologist the same day and evaluates the presence of wrists synovitis and fifth and sixth extensor compartment damage. Results: 34 patients were included, 80% female, median age 56 years (IQR: 30-84). The median disease duration was 114 months (IQR: 14-540). 68 wrists were evaluated. The piano key sign wasobserved in 36.7%. In wrists with the piano key sign, US synovitis was observed in 96% and at the wrists without the sign we observedsynovitis in 83.7%. At the sixth compartment, we observed tendinosis in 16% of the patient who had the piano key sign vs. 28% without the sign, and tenosynovitis in 28% vs. 14, respectively. Conclusions: This study is the first in our country to compare thepresence of the piano key sign with the ultrasonographic findings in de wrist and his fifth and sixth extensor compartment. The data collected enables us to suppose that there is no association between the presence of the clinical sign and the ultrasonographicfindings.(AU)
Assuntos
Artrite Reumatoide , UltrassonografiaRESUMO
Over the last few years, a growing number of rheumatologists has taken great interest in ultrasonography for its well known advantages and wide spectrum of validated applications in daily rheumatological practice. Most rheumatologists actively performing ultrasonography have had a training experience mainly based on attendance in sonographic courses and/or in radiological or rheumatological units. At present, in Mexico ultrasonography has a still limited diffusion among rheumatologists even if it may play a key role as a first line imaging technique also because of the restricted availability for rheumatic patients for other imaging modalities. This report describes the Mexican experience in education and training on musculoskeletal ultrasound. In 2003, the Mexican School of Musculoskeletal Ultrasound of the Mexican College of Rheumatology (ECOMER) was founded with the intention of joining efforts to launch musculoskeletal ultrasound in Mexico. Essential requirements shared by all the members of ECOMER include: to own an ultrasound machine, to incorporate ultrasonography into clinical daily practice and to keep up-to-date in musculoskeletal ultrasound. The motto of ECOMER is una clara imagen de la reumatologia which means a clear picture of rheumatology. The statute of ECOMER can be read in its web site: www.ecomer.org.mx. This web site also provides a forum for case discussion, consultation and image review.