AB1255 Sonographic assessment of normal peripheral joints: Evaluation according to joints, age and demographic variables

Abstract

Background To the best of our knowledge, no previous reports have addressed concomitantly quantitative and semi-quantitative sonographic measurements obtained from several peripheral joints of healthy people, and compared them among different age groups. Objectives To describe quantitative and semi-quantitative ultrasound measurements in healthy joints and compare them among different age groups. Methods Bilateral ultrasound measurement of small, medium and large joints were performed in 130 healthy adult volunteers, stratified into five age groups (A: 18-29, B: 30-39,C: 40-49, D: 50-59, E: 60-80 years), totalizing 46 joint recesses per patient. Sonographic measurements were correlated with age group and demographic variables: age, BMI, gender, skin color, smoking history and physical activity. My Lab 60 XVision machine (Esaote, Biomedica - Genova, Italy) with a linear probe (6-18 MHz) was used. Quantitative measurements of synovial recess (QSR) (mm) and semi-quantitative measures of synovial hypertrophy (SSH), Power Doppler (SPD) and bone erosion (SBE) (score 0-3), were performed. Articular cartilage (AC) at dorsal 2nd and 3rd metacarpophalangeal (MCP) were also evaluated (score 0-4). Results 5,980 joint recesses were studied in 130 healthy adults; mean age 44.84, 76,9% women, 62,3% white. The mean (±SD) of QSR (mm) was: radiocarpal 2.0 (0.62); distal radioulnar 1.48 (0.37); ulnocarpal 1.39 (0.56); dorsal 2nd MCP 1.04 (0.54); palmar 2nd MCP 0.93 (0.66); dorsal 3rd MCP 0.81 (0.60); palmar 3rd MCP 0.83 (0.67); dorsal 2nd proximal interphalangeal joint of the hand (PIP) 0.47 (0.27); palmar 2nd PIP 0.85 (0.31); dorsal 3rd PIP 0.47 (0.35); palmar 3rd PIP 0.86 (0.35); coronoid fossa 1.07 (1.11); olecranean fossa 1.25 (1.16); glenohumeral (GH) axillary recess 2.46 (0.60); posterior GH recess 2.45 (0.52); hip 6.35 (1,25); knee 2.13 (1.47); talocrural (TC) 2.21 (1.09); talonavicular (TN) 2.61 (1.11); subtalar (ST) 2.16 (1.15), dorsal 1st metatarsophalangeal (MTP) joint 2.16 (0.83); dorsal 2nd MTP 2.32 (0.86); dorsal 5th MTP 0.73 (0.68). The largest QSR measurements (p<0.02) were observed in age groups D and E at the recesses: dorsal 2nd and 3rd PIP, dorsal 2nd and 3rd MCP, dorsal 5th MTP, palmar 2nd and 3rd MCP, olecranean fossa, TC and ST. The worst SSH scores (p<0.02) were observed at age groups D and E in the recesses: palmar 2nd and 3rd MCP, palmar 2nd and 3rd PIP, dorsal 2nd and 3rd PIP, dorsal 3rd MCP, 5th dorsal MTP, TN and ST. The worst SPD scores (p<0.016) were observed in age group E at the dorsal 3rd PIP and 3rd MCP. The worst SBE scores (p<0.041) were observed in age group E at the recesses: radiocarpal, ulnocarpal and posterior GH. Minor AC changes (score 1) (p<0.001) were observed in age groups D and E at the dorsal 2nd and 3rd MCP. There were few occasional correlations among ultrasound measurements and demographic variables. Inter-observer reliability (r) for the quantitative and semi-quantitative measurements ranged from 0.563 to 0.872 and 0.341 to 0.823, respectively. Conclusions Articular sonograph...

The relevance of ultrasound examination of the foot and ankle in patients with rheumatoid arthritis – a review of the literature

“…Machado et al [20] assessed healthy adults for US changes in multiple joints, including the forefoot, and identified high-grade synovial hypertrophy most frequently in 1 st and 2 nd MTP (69.3%, 78.8% respectively), having also a PD signal, especially in the 1 st MTP (15.8%).…”

Hallazgos ultrasonográficos a nivel de articulaciones de manos y pies en sujetos voluntarios asintomáticos

“…24 . Otros trabajos coinciden de la misma manera en resaltar el elevado compromiso de las articulaciones metatarsofalángicas por derrame articular y sinovitis posiblemente en el contexto de estrés biomecánico y/o cambio s degenerativos incipientes asintomáticos 13,17,18 .…”

“…Hallazgos ultrasonográficos a nivel de articulaciones de manos y pies en sujetos voluntarios asintomáticos El ocho por ciento de los voluntarios mostraron alteraciones ultrasonográficas en los recesos radiocarpianos, y del total de anormalidades allí documentadas, el 60% correspondieron a sinovitis (92% grado 1) y 40% a derrame articular (78% grado 1 y 22% grado 2). Éste compromiso también lo describe Machado y colaboradores 18 , sin embargo, un porcentaje importante de esos recesos se encontraron asociados a erosiones y señal doppler de poder. En la artritis reumatoide la articulación más frecuentemente involucrada a nivel de la mano es la muñeca, llegando a comprometerse en el 75% de ellos, y es específicamente su aspecto cubital el que casi siempre se convierte en el primer sitio en afectarse [38][39][40][41] .…”

“…En lo referente a la neoangiogénesis, ésta representa el primer paso en la cascada inflamatoria de la sinovitis que finalmente lleva al desarrollo de erosiones 36 . A pesar de que en varios estudios se ha registrado señal doppler de poder en articulaciones de sujetos sanos [13][14][15][16]18,24,42 , en el grupo de sujetos evaluados ésta no se identificó a nivel de las manos a pesar su perfil sociodemográfico predominante.…”

“…Se dispone de poca información publicada en la literatura en referencia a los hallazgos ultrasonográficos articulares de sujetos asintomáticos y su relación con aspectos sociodemográficos. Machado y colaborares 18 , demostraron que la asociación de sus mediciones semicuantitativas con las características sociodemográficas fueron muy esporádicas e inconsistentes en los 130 voluntarios sanos evaluados. Por el contrario, nuestro trabajo permitió demostrar relación positiva entre derrame articular e hipertrofia sinovial con variables como la edad, ocupación manual exclusiva y tiempo laboral mayor Capítulo 6.…”