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ULTRASOUND EVALUATION OF THE ANKLE JOINTS AND TENDONS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Ljiljana Smiljanić Tomičević orcid.org/0000-0003-2807-7440 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, Zagreb
Darija Čubelić ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, Zagreb
Miroslav Mayer ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, Zagreb

Sažetak

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with musculoskeletal involvement as one of the most common and earliest clinical manifestations which occur in 95% of patients. High-resolution ultrasound (US) already proved to be a useful diagnostic tool for the evaluation of pathological changes of the joints and tendons in the majority of inflammatory rheumatic diseases. There are no studies that evaluate the frequency of involvement of ankle joints in adult patients with SLE.
Objectives: Th e aim of this study is to asses the frequency of ankle joints and tendons involvement in SLE patients using US and correlate the findings with physical examination, laboratory tests, and disease activity scores. Here we will show preliminary results of the survey in the first 10 out of 60 included patients. Methods: Ten consecutive SLE patients were enrolled in the study and underwent clinical evaluation, laboratory tests and bilateral high-resolution US on the same day. Gray scale and power Doppler (PD) US were performed for imaging the talocrural (TC), subtalar joints (ST) and ankle tendons, then second and third MCP joints, second and third PIP joints, wrists and second and third MTP joints. Ankle inflammatory US score and global inflammatory US score were calculated.
Results: Preliminary results in 10 patients show the US detected inflammatory joint abnormalities in 7/10 (70%) patients and tendon involvement in 1/10 (10%). A total of 180 joints and 200 tendons were examined. Both of MTP and TC joints were affected in 60% patients, MCP joints in 50%, ST in 40%, wrists in 30% and PIP joints in 10% of patients. Th e most prevalent pathological US finding was joint effusion, less frequently synovial hypertrophy while positive PD signal was rarely presented. Only one patient had bony erosion detected. Effusion in TC joints was present in 60% patients, synovial hypertrophy in 40% and positive PD in 10%. As many as 62,5% of patients without inflammatory joint symptoms had pathological US findings in ankle joints. Th e global US inflammatory score had a mean value of 5,6, and ankle US inflammatory mean value score 2,9. Conclusions: Results of the preliminary study show a high prevalence of US verified inflammatory joint changes in SLE patients. Surprisingly, the foot and ankle joints were most commonly affected and a great number of asymptomatic patients had pathological US findings in ankle joints. 1. Iagnocco A, Ceccarelli F, Rizzo C, Truglia S, Massaro L, Spinelli FR, et al. Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus. Rheumatology. 2014;53(3):465–72.
2. Delle Sedie A, Riente L, Scire CA, Iagnocco A, Filippucci E, Meenagh G, et al. Ultrasound imaging for the rheumatologist XXIV. Sonographic evaluation of wrist and hand joint and tendon involvement in systemic lupus erythematosus. Clin Exp Rheumatol. 2009;27(6):897–901.
3. Iagnocco A, Epis O, Delle Sedie A, Meenagh G, Filippucci E, Riente L, et al. Ultrasound imaging for the rheumatologist. XVII. Role of colour Doppler and power Doppler. Clin Exp Rheumatol. 2008 Oct;26(5):759 62.
4. Porta F, Radunovic G, Vlad V, Micu MC, Nestorova R, Petranova T, et al. Th e role of Doppler ultrasound in rheumatic diseases. Rheumatology. 2012;51(6):976–82.

Ključne riječi

Hrčak ID:

210516

URI

https://hrcak.srce.hr/210516

Datum izdavanja:

5.12.2018.

Posjeta: 419 *