Prognostički značaj ultrazvučnog nalaza u proceni strukturnog oštećenja zglobova šaka i stopala kod bolesnika sa početnim reumatoidnim artritisom

Abstract

Dosada[nja istraživanja ukazuju na pouzdanost primene muskuloskeletnog ultrazvuka (MSUZ) u oceni nalaza inflamacije kao i strukturnog oštećenja na perifernim zglobovima. Cilj ovog rada je bio da se proceni strukturno oštećenje na zglobovima šaka i stopala kod bolesnika sa dijagnozom ranog reumatoidnog artritisa (RA) i trajanjem simptoma bolesti ≤12 meseci, primenom MSUZ i utvrditi prognostički značaj bazalnog ultrazvučnog (UZ) nalaza nakon 6 meseci lečenja bolesnika. Metod. U studiju praćenja uključeno je 65 bolesnika, sa dijagnozom ranog RA (EULAR/ACR kriterijumi iz 2010 godine), trajanja ≤12 meseci postavljenom u ambulantnim/bolničkim uslovima Instituta za reumatologiju u Beogradu, u periodu 2012-2014. god. Uključujući kriterijumi za istraživanje bili su: 1. odsustvo predhodne primene glikokortikoidne/DMARD terapije 2. odsustvo nalaza strukturnih promena na urađenoj radiografiji šaka i stopala 3. odsustvo drugih inflamacijskih ili degenerativnog oboljenja zglobova težeg stepena. Kontrolnu grupu je činilo 30 zdravih. Na početku/ nakon 6 meseci praćenja, urađeni su: pregled sistema za kretanje; UZ pregled zglobova šaka i stopala, prema preporukama OMERACT grupe experata. Pregled je obavljen lineranom sondom, 8-16 MHz, aparata Esaote My Lab- 70. Nalaz inflamacije na zglobovima ocenjivan je semikvantitativno (Sckudlarek-ov metod) a U Z n alaz erozije kvalitativno uz ocenu veličine i zapremine iste; laboratorijski nalazi: brzina sedimentacije eritrocita (SE), C reaktivni protein (CRP), nalaz i koncentracija reumatoidnog faktora (RF), antitela na ciklični citrulisani peptid (ACPA) i matrixmetaloproteinaze 3 (MMP-3); radiografsko snimanje šaka i stopala; ispitivanje funkcijskog statusa (HAQ upitnik); posle 6 meseci MR šaka. Podaci su obrađeni u SPSS 16 sistemu...

Musculoskeletal ultrasound (MSU) is been proven clinical method in reliable both joints inflammation and structural damage assessing. The aims of this study were to evaluate structural damage progression of the hands and feet joints assessed by ultrasonography (US), in patients (pts) with early, treatment naïve rheumatoid arthritis (RA), without X-ray visible erosions, and to estimate the prognostic value of basal ultrasound (UZ) findings after 6 months of treatment. Method. Sixty-five pts with symptoms duration of ≤12 months and diagnosis of early RA, according to the 2010 (ACR/EULAR) classification criteria, in Institute of rheumatology in Belgrade, were included in a prospective clinical study during the 2012-2014 yrs.. The following including criteria had to be fulfilled 1. absence of prior use of glycocorticoid / DMARD therapy; 2. absence of finding of structural damage on X-ray of the hands and foot 3. absence of the others inflammatory or severe degenerative joint‘s disorders. The 30 healthy control, were recruited among the staff of the Institute. At the study entry and after 6 months of treatment, all pts. were underwent on: clinical examination; laboratory testing (ESE, CRP, RF, ACPA, MMP- 3); radiographic and US examination which was performing by 16 MHz linear probe of Esaote My Lab 70 high resolution machine. OMERACT US group definition was used to detect the presence of synovial fluid and hypertrophy, PD signal, as well as bony erosion presence, at the level of hands and feet joints. US findings was assessed by Sckudlarek semiquantitaive method. The size and volume of erosions were rated. After 6 months MR of hand was performed. The data were processing in SPSS package. Results: Complete results were obtained from 63 included pts...