Produção Nacional
Associação entre achados ultrassonográficos e clínicos do quadril de pacientes com artrite idiopática juvenil
2013; Elsevier BV; Volume: 53; Issue: 4 Linguagem: Inglês
10.1590/s0482-50042013000400002
ISSN1809-4570
AutoresVanessa Bugni Miotto e Silva, Giampaolo Faquin, Aline Nicácio, Rodrigo Regacini, Henrique Manoel Lederman, Maria Odete Esteves Hilário, Maria Teresa Terreri,
Tópico(s)Streptococcal Infections and Treatments
ResumoDescrever os achados ultrassonograficos do quadril em pacientes com artrite idiopatica juvenil (AIJ) e sua associacao com sinais, sintomas e atividade da doenca. Estudo retrospectivo com 92 pacientes com AIJ. Foram avaliados os subtipos da doenca, a idade de inicio, o tempo de evolucao, a atividade da doenca e as manifestacoes clinicas do envolvimento do quadril. A avaliacao ultrassonografica foi realizada na rotina dos pacientes, e as imagens foram analisadas por dois ultrassonografistas cegos em relacao as condicoes clinicas dos pacientes. Do total de 92 pacientes, 69,6% eram meninas, com media de idade de 12,4 ± 5,1 anos. Trinta e tres (35,9%) apresentaram subtipo oligoarticular persistente e trinta (32,6%) poliarticular com fator reumatoide negativo. Quarenta e quatro (47,8%) apresentaram sinal e/ou sintoma relacionado ao quadril. Vinte e nove (31,5%) apresentaram alteracoes ultrassonograficas, com sinovite subclinica em 34,4%. As alteracoes ultrassonograficas se associaram com presenca de sinais e/ou sintomas do quadril (P = 0,021), especialmente limitacao articular (P = 0,006), mas nao com atividade (P = 0,948) ou subtipo de doenca (P = 0,108). Sinovite clinica se associou com comprometimento poliarticular (P = 0,002) e atividade de doenca (P = 0,017). Nao houve associacao entre sinovite subclinica e as variaveis estudadas. O acometimento clinico do quadril na AIJ, especialmente a limitacao articular, esta associado a sinovite na avaliacao por US, independente do subtipo e da atividade da doenca. Os profissionais de saude devem estar atentos a possibilidade de doenca silenciosa com sinovite subclinica, que pode contribuir para a deterioracao da articulacao do quadril. To describe the ultrasonographic (US) findings in the hips of patients with juvenile idiopathic arthritis (JIA) and the association between these findings and the signs, symptoms, and activity of the disease. The present retrospective study included 92 patients with JIA. The disease subtypes, age at disease onset, length of disease progression, disease activity, and clinical manifestations of the hip pathology were assessed. US examinations were routinely performed, and the images were analysed by two ultrasonographers who were blinded to the patients’ clinical conditions. Of the 92 patients included in the study, 69.6% were girls, and the average age was 12.4 ± 5.1 years. Thirty-three (35.9%) participants exhibited the persistent oligoarticular subtype, and 30 (32.6%) exhibited the rheumatoid factor (RF)-negative polyarticular subtype. Forty-four participants exhibited signs and/or symptoms of hip pathology. Twentynine (31.5%) participants exhibited abnormal US findings, and 34.4% exhibited subclinical synovitis. The US alterations exhibited an association with subclinical synovitis in 34.4% of the cases. The US alterations bore a correlation with the presence of hip-related signs and/ or symptoms (P = 0.021), particularly joint limitations (P = 0.006), but were not correlated with the disease activity (P = 0.948) or subtype (P = 0.108). Clinical synovitis was associated with polyarticular involvement (P = 0.002) and disease activity (P = 0.017). Subclinical synovitis was not correlated with the investigated variables. Clinical affection of the hip in JIA, particularly joint limitation, is associated with synovitis (revealed by US assessment) independently of the activity and subtype of the disease. Therefore, healthcare professionals should consider the possible occurrence of silent disease and subclinical synovitis, which might contribute to hip deterioration.
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