ULTRAZVUČNA EVALUACIJA ZGLOBOVA I TETIVA GLEŽNJA U SUSTAVNOM ERITEMSKOM LUPUSU

Ljiljana Smiljanić Tomičević, Darija Čubelić, Miroslav Mayer, Branimir Anić

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with musculoskeletal involvement as one of the most common clinical manifestations. High-resolution ultrasound (US) has been proven to be a useful diagnostic tool for the evaluation of joints and tendons in the majority of inflammatory rheumatic diseases. The aim of this study is to assess the frequency of ankle joint and tendon involvement in SLE patients with the use of US, and correlate the findings with the 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. 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 of the talocrural (TC) and subtalar joints (ST), ankle tendons, second and third metacarpophalangeal (MCP) joints, second and third proximal interphalangeal (PIP) joints, second and third metatarsophalangeal (MTP) joints, and wrists. A total of 180 joints and 200 tendons were examined. Preliminary results showed US-detected inflammatory joint abnormalities in 7/10 (70%) patients and tendon involvement in 1/10 (10%). Both the MTP and TC joints were affected in 60% of the patients, MCP joints in 50%, ST in 40%, wrists in 30%, and PIP joints in 10% of the patients. The most prevalent pathological US finding was joint effusion, less frequently synovial hypertrophy, while a positive PD signal was rarely detected. Effusion in the TC joints was present in 60% of the patients, synovial hypertrophy in 40%, and a positive PD in 10%. As many as 62.5% of the patients without inflammatory joint symptoms had pathological US findings in the ankle joints. The results showed a high prevalence of US-verified inflammatory joint changes in SLE patients. Surprisingly, the MTP and ankle joints were most commonly affected. Additionally, a great number of asymptomatic patients also had pathological US findings in the ankle joints.

Sustavni eritemski lupus (SLE) kronična je autoimunosna bolest s afekcijom muskuloskeletnog sustava kao jednom od najčešćih manifestacija. Ultrazvuk visoke rezolucije (UZ) dokazao se kao korisno dijagnostičko sredstvo pri evaluaciji zglobnih i tetivnih promjena u većini upalnih reumatskih bolesti. Cilj je ove studije odrediti učestalost zahvaćanja zglobova i tetiva gležnja u bolesnika sa SLE-om koristeći se UZ-om te korelirati rezultate s fizikalnim pregledom, laboratorijskim nalazima i mjerama aktivnosti bolesti. Prikazali smo preliminarne rezultate studije na prvih 10 od ukupno 60 bolesnika. Uključeno je 10 uzastopnih pacijenata sa SLE-om koji su istog dana podvrgnuti kliničkoj evaluaciji, laboratorijskom ispitivanju i ultrazvučnom pregledu. Ultrazvučno su obostrano pregledani talokruralni (TC) i suptalarni (ST) zglobovi, tetive gležnja, drugi i treći metakarpofalangealni (MCP) zglobovi, drugi i treći proksimalni interfalangealni (PIP) zglobovi, drugi i treći metatarzofalangealni (MTP) zglobovi te ručni zglobovi. Ukupno je pregledano 180 zglobova i 200 tetiva. Preliminarni rezultati pokazuju ultrazvučno detektirane upalne zglobne promjene u 7/10 (70%) bolesnika i zahvaćenost tetiva u 1/10 (10%). MTP i TC zglobovi bili su zahvaćeni u 60% bolesnika, MCP zglobovi u njih 50%, ST u 40%, ručni zglobovi u 30%, dok su PIP zglobovi bili zahvaćeni u 10% bolesnika. Najčešći patološki ultrazvučni nalaz bio je zglobni izljev, nešto rjeđe sinovijalna hipertrofija, dok je pozitivan PD signal rijetko bio prisutan. Izljev u TC zglobovima detektiran je u 60% bolesnika, sinovijalna hipertrofija u njih 40%, a pozitivan PD u 10% bolesnika. Čak 62,5% asimptomatskih bolesnika imalo je patološki nalaz na UZ-u gležnjeva.Rezultati pokazuju veliku prevalenciju ultrazvučno verificiranih upalnih promjena zglobova u pacijenata sa SLE-om. Iznenađuje da su najčešće bili zahvaćeni zglobovi stopala i gležnja. Također, bitno je naglasiti da je velik broj asimptomatskih bolesnika imao patološki ultrazvučni nalaz zglobova gležnja.