R.D. Takahashi

Sonographic Assessment of Healthy Peripheral Joints Evaluation According to Demographic Parameters

To describe quantitative and semiquantitative sonographic joint measurements in healthy adults and compare them with demographic parameters.

Hand ultrasound: Comparative study between “no rhupus” lupus erythematosus and rheumatoid arthritis

Abstract Objective. To compare hand US between systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients. Methods. Hands (1st–5th metacarpophalangeal [MCP] and 1st–5th proximal interphalangeal [PIP] joints) and wrists (radiocarpal and distal radioulnar joints) of 62 “no rhupus” SLE and 60 RA patients were compared through US (linear probe, 6–18 MHz). The findings were compared to clinical, functional, serological outcomes, and disease activity indices. Results. 2108 and 2040 joint recesses were evaluated in SLE and AR patients, respectively. Synovitis was found in 46.8% and 75% of wrists, 83.9% and 86.7% of MCPs and 58.1% and 70% of PIPs in the SLE and RA groups, respectively. More significant US findings were found in RA group. Greater values of synovitis (mm) in RA group were only found in the joint recesses of wrist (p < 0.001–0.002). In SLE group, US findings were associated with “puffy hands,” Health Assessment Questionnaire score and dynamometry. Twenty-two SLE patients (35.5%) had erosion in any of joints studied. SLE patient subgroup with US erosion was associated with hematological involvement and Jaccouds arthropathy. Conclusions. US of “no rhupus” SLE and RA patients is different, especially in wrists. In SLE patients the clinical variable most associated with US findings was “puffy hands.”

SONOGRAPHIC CUTOFF VALUES FOR DETECTION OF ABNORMALITIES IN SMALL, MEDIUM AND LARGE JOINTS: A COMPARATIVE STUDY BETWEEN PATIENTS WITH RHEUMATOID ARTHRITIS AND HEALTHY VOLUNTEERS

To determine ultrasound measurements indicative of abnormalities in small, medium and large joints, we conducted a cross-sectional study comparing 60 patients with rheumatoid arthritis (RA) and 78 healthy volunteers. A MyLab 60 ultrasound machine (Esaote) and a linear multifrequency probe were used. Quantitative measurements of synovial recesses and semiquantitative measurements of synovial hyperplasia, power Doppler and bone erosion (scores = 0-3) were performed. The cutoff values for synovial recesses indicating RA (receiver operating characteristic curve, area under the curve >0.800) were found to be (radiocarpal) 3.78 mm and (ulnocarpal) 3.07 mm. Those measurements with the greatest chance of indicating RA (logistic regression analysis expressed as odds ratios [ORs]) were (p < 0.001) measurements of synovial hyperplasia (ulnocarpal, OR = 100, and radiocarpal, OR = 70); synovial power Doppler (radiocarpal, OR = 66); synovial bone erosion (radiocarpal, OR = 324); fifth metatarsophalangeal joint (OR = 100); and second metacarpophalangeal joint (OR = 92). We concluded that for both quantitative and semiquantitative ultrasound measurements, radiocarpal abnormalities increase the chance of detecting RA.

FRI0232 Articular Sonography in Healthy Individuals: Comparison among Small, Medium and Large Joints

Background Standardization of articular ultrasound is still needed, thus the importance of studies that help to understand the articular anatomy in a significant sample of healthy individuals. Objectives To identify which recesses in each joints size group (small, medium or large joints) have the highest sonographic measurements in a sample of healthy volunteers. Methods A cross-sectional study was conducted on a sample of 130 asymptomatic healthy adults aged between 18 to 80 years. Quantitative measurements of synovial recess (QSR) (mm) and semiquantitative measurements of synovial hypertrophy (SSH), Power Doppler (SPD) and bone erosion (SBE) (score 0-3) were performed in small - volar and dorsal 2-3 metacarpophalangeal (MCP), dorsal and volar 2-3 proximal interphalangeal (PIP) of the hands, dorsal 1st, 2nd and 5th metatarsophalangeal (MTP); medium - radiocarpal, ulnocarpal, distal radioulnar joint, coronoid and olecranon fossa, tibiotalar, subtalar and talonavicular recesses; and large - axillary and posterior recesses of the shoulder, knee and hip joints. Measurements were compared to identify which recesses had the highest measurements within each joints size group (small, medium or large). A My Lab 60 Xvision ultrasound machine (Esaote, Biomedical – Geneva, Italy) by means of a 6-18 MHz linear array transducer was used. Mann-Whitney U and Kruskal-Wallis non-parametrical tests and Chi squared or Fishers Exact tests were used to compare continuous and categorical data, respectively. Significant p value was set at 5%. Results 6.500 joint recesses were studied in 130 healthy adults; mean age 44.84 years, 76.9% women, 62.3% white. Highest measurements of QSR were found in 2nd MTF (2.33±0.83mm) and 1st MTP (2.14mm±0.84) (p<0,001), talonavicular recess (2.67+1.10mm) (p<0,001) and hip (6.16+1.10mm) (p<0,001), respectively for the small, medium and large joints. The worst scores of the semiquantitative measurements were found: for SSH (scores 2 and 3) - 1st and 2nd MTP (p<0,001), talonavicular recess (p<0,001); hip and knee joints (p<0,001), respectively for small, medium and large joints; for SPD (scores 1, 2 and 3) - 1st MTP (p<0,001) and radiocarpal recess (p<0,001), respectively for small and medium joints; for SBE (scores 2 and 3) - radiocarpal and ulnocarpal recesses (p<0,001) and posterior recess of the glenohumeral joint (p<0,001), respectively for small and medium joints. There were no statistical differences among recesses in large joints for SPD and in small joints for SBE. Conclusions The highest quantitative measurements were observed in 1st and 2nd MTP, talonavicular and hip joints. For semiquantitative measurements, the recesses that showed repeatedly the worst scores were the 1st MTP and the radiocarpal recess. References Szkudlarek M, Court-Payen M, et al (2001). Szkudlarek M, Court-Payen M, et al (2003). Wakefield RJ, Balint PV, et al (2005). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3932

Avaliação por imagem dos quadros dolorosos da face ulnar do punho

Os quadros dolorosos da face ulnar do punho têm sido um desafio diagnóstico para reumatologistas, radiologistas e cirurgiões da mão. A complexidade e as pequenas dimensões das estruturas anatômicas, a diversidade de alterações que podem causar sintomas e a alta incidência de alterações aos exames de imagem em pacientes assintomáticos são alguns dos fatores que levam às dificuldades diagnósticas e de tratamento desta região. Esses quadros dolorosos já foram chamados “dor lombar do punho”, por causa de sua instalação insidiosa, apresentação com sintomas vagos e crônicos e pela frustração que gera nos pacientes, sendo encontrados na literatura relatos de até 44 diferentes entidades a serem consideradas nos diagnósticos diferenciais de dor nessa localização(1). Para se tentar sistematizar a busca por lesões e reduzir o número de diagnósticos a serem considerados, os quadros de dor ulnar podem ser divididos em seis elementos de origem: ósseo, ligamentar, tendíneo, vascular, neurológico e miscelânea. As lesões ósseas incluem seqüelas de fraturas, processos degenerativos, síndromes de impacto, entre outras alterações (Figuras 1, 2 e 3). Lesões ligamentares podem ocorrer em quaisquer dos ligamentos intrínsecos ou extrínsecos desta região. Podem ainda ser consideradas as lesões do complexo da fibrocartilagem triangular (CFCT), tendinopatias do extensor ulnar do carpo (TEUC) ou flexores do carpo (Figura 4), além de lesões vasculares, como trombose da artéria ulnar (Figura 5) e hemangiomas. Processos neurológicos incluem, por exemplo, o encarceramento do nervo ulnar no canal de Guyon. Finalmente, no grupo miscelânea, encontram-se entidades raras, como osteoma osteóide, condroblastomas e cistos ósseos aneurismáticos(2). Este artigo abordará as causas mais Avaliação por Imagem dos Quadros Dolorosos da Face Ulnar do Punho