Diagnostic value of ultrasound in the detection of rheumatoid arthritis

Transcription

1 Diagnostic value of ultrasound in the detection of rheumatoid arthritis Poster No.: B-1054 Congress: ECR 2014 Type: Scientific Paper Authors: J. F. Castro Costa 1, L. A. Torres 1, J. L. M. O. Belo 1, Ó. M. D. C. Tavares 2, A. C. P. SARAIVA 2, T. Patrão 1 ; 1 Castelo Branco/PT, 2 Coimbra/PT Keywords: DOI: Bones, Extremities, Musculoskeletal joint, Ultrasound, Conventional radiography, Laboratory tests, Comparative studies, Arthritides /ecr2014/B-1054 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 10

2 Purpose The main goal of this study is to emphasize the diagnostic capacity of Ultrasonography in Rheumatoid Arthritis (RA) and show its importance as a possible and efficient first line examination in the detection of this pathology. Methods and materials In this investigation, 60 patients were studied, with ages between 27 and 51 years old, in a period between April 17, 2011 and July 8, The RA was diagnosed after the realization of imagiological exams, more specifically radiographies and echographies. The positive laboratory analysis (Nephelometry tests) indicated only one suspicion of RA. Radiographic evaluation of both hands was performed in the Conventional Radiology equipment from Philips, Optimus 80 model, using two basic incidences, the AP (Antero- Posterior) and oblique incidence (Noorgard method). However, only the second and third fingers were studied. The ultrasonographic evaluation was performed with resource to the Logiq P6 echograph from General Electric and a 7.5 MHz high frequency probe. During this evaluation, the patient was sit in front of the rheumatologist, with both hands in supine position, immobilized and in complete extension. The joints in study were the MCF and the IFP from the second to the third fingers, bilaterally, where sagittal sections were carried with an anterior view. This evaluation was performed by a radiologist with an extensive experience in musculoskeletal ultrasonography, as well as in the elaboration of the medical report. In the laboratory evaluation, for the quantification of the Rheumatoid Factor (RF), through the Nephelometry test, it was used an apprpriate analysis equipment of the brand Siemens, BN Propect model. In this evaluation, the reference values used were: RF between 20 and 79 Ul/ml, being these values considered as 'low reactive'', and RF equal or superior to 80 Ul/ml, considered ''reactive''. Results In a sample of 60 patients, aged between 27 and 51 years old, we verified that 35 (58.3%) were female and 25 (41.7%) were male. Accordingly, it is possible to infer that the most affected sex is the female, in a ratio of 7:5 (Fig.1/Table 1). In this same sample, we verified Page 2 of 10

3 that both age groups were affected, being more frequent in women from 33 to 41 years and men from 36 to 41 years old (Fig.2/Table 2). In the studied sample two imagiological techniques were applied, respectively Conventional Radiology and Ultrasonography. Through the performed exams, which were aimed to quantify the number of bone erosions, we verified that Ultrasonography detects in mean a bigger number of bone erosions when compared to Conventional Radiology, being these values, respectively, 4,62 and 3,28 (Fig.3/Table 3). Through the Post-Signal test of Wilcoxon (Fig.4/Table 4), we can verify that from the 60 studied patients, 44 show a major number of bone erosions when using the Ultrasonography technique, unlike the only 3 individuals that present a major number of bone erosions when using the Conventional Radiology. The remainder 13 individuals show the same number of bone erosions in both imagiological techniques. This difference is verified by the p-value=0,000. Through the scatter plots in Fig. 5 and 6, it is possible to see that doesn't exist an increase of RF in accordance to the increase of the number of bone erosions visualized in both imagiological techniques, since this values are too much disperse. However, it is possible to verify by the Table 5 (Fig.7) that in 60 individuals, 12 present a Rheumatoid Factor between 20 Ul/ml e os 79 Ul/ml ("low reactive"), while the remainder 48 individuals exhibits a Rheumatoid Factor equal or superior to 80 Ul/ml ("reactive''), which represents, respectively, 20% and 80% of the population in study. With a p-value=0,000, we verified once again that the Ul/ml mean is different in both group. Images for this section: Fig. 1: Table 1 - Frequency distribution of sex Page 3 of 10

4 Fig. 2: Table 2 - Distribution of patients numbers by sex and age group Fig. 3: Table 3 - Univariate analysis of the number of bone erosions visualized in Conventional Radiology and Ultrasonography Page 4 of 10

5 Fig. 4: Table 4 - Post-Sign test of Wilcoxon for the number of bone erosions visualized in Ultrasonography and the number of bone erosions visualized in Conventional Radiology Page 5 of 10

6 Fig. 5: Scatter plot of the number of bone erosions visualized in Conventional Radiology in function of Rheumatoid Factor Page 6 of 10

7 Fig. 6: Scatter plot of the number of bone erosions visualized in Ultrasonography in function of Rheumatoid Factor Page 7 of 10

8 Fig. 7: Table 5 - Mann-Whitney-Wilcoxon test for the number of bone erosions visualized with conventional radiology technique as a function of Rheumatoid Factor Page 8 of 10

9 Conclusion Rheumatoid Arthritis reaches both genders at any age group, which, revealing in the studied sample, is most common in Women between 33 and 41 years old and in Men between 36 and 41 years old. The diagnostic capacity of Ultrassonography in the diagnose of Rheumatoid Arthritis is bigger than in Conventional Radiology. Ultrasound is a supplementary diagnosis exam that can be used as a first line examination in the detection of Rheumatoid Arthritis. This one is a technique that presents a larger number of advantages when compared to the Conventional Radiology such: detects a greater number of bone erosions and do not use ionizing radiation. A high Rheumatoid Factor is not correlated with the number of bone erosions visualized in Conventional Radiology and in Ultrassonography. This method should be used as a complement of imagiological exams imaging studies, since it only indicates a probability. Personal information References Backhaus, M., Burmester, G. R., Gerber, T., Grassi, K. P., Machold, W., Swen, A., et al. (2001). Guidelines for musculoskeletal ultrasound in rheumatology. Annals Rheumatic Diseases, pp Baillet, A., Gaujoux-Viala, C., Mouterde, G., Pham, T., Tebib, J., Saraux, A., et la. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis Gibson, N., & Kissin, E. Y. The pros and cons of Ultrasonography for rheumatological conditions. The Journal of Musculoskeletal Medicine 2011, 28. Lin, J., Fessel, D. P., Jacobson, J. A., Weadock, W. J., & Hayes, C. W. (September of 2000). An ilustrated tutorial of musculoskeletal sonography:part 1, introduction and general principles. American Journal of Roentgenology, pp Page 9 of 10

10 Ostergaard, M., & Szkudlarek, M. (2003). Imaging in Rheumatoid Arthritis - Why MRI andultrasonograohy can no longer be ignored. Scandinavian Jounal of Rheumatology, pp Queiroz, M. V. (2006). Doenças Reumáticas em 12 lições. Lisboa: Lidel. Rahamani, M., Chegini, H., Najafizadeh, S. R., Azimi, M., Habiblollahi, P., & Shakiba, M. Detection of bone erosion in early rheumatoid arthritis: Ultrasonography and conventional radiology versus non-contrast magnetic resonance imaging. Clinical Rheumatology 2010, 29: Silveira, D. W., Boery, E. N., & Boery, R. N. (2006). Reflexões acerca da crioterapia na fase aguda da Artrite Reumatóide e suas correlações com a crioglobulinemia. Revista de Saúde Comunitária, pp Taylor, P. C. (2003). The value of sensitive imaging modalities in Rheumatoid Arthritis.Arthritis Research & Theraphy, pp Wakefield, R. J., Brown, A., O'Connor, P., Grainger, A., Karim, Z., McGonagle, D., et al. (2003). Rheumatological Ultrasound. Rheumatology, pp Page 10 of 10