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Abstract(s)
Introdução: A hiperuricémia é um achado comum em pacientes com psoríase (Pso) e artrite psoriática (APso). A ultrassonografia (US) tem demonstrado ser uma técnica de imagem válida para estudar o envolvimento músculo-esquelético em pacientes com gota. Os principais achados ultrassonográficos relacionados com a deposição de cristais de monourato de sódio (MSU) são: tofos, sinal de duplo contorno (DCS) e erosões ósseas. Focos hiperecogénicos intra-articulares e intra-tendinosos e derrame intra-articular também têm sido descritos.
Objetivos: Investigar a presença de achados US compatíveis com depósitos de MSU na cartilagem hialina, articulações e tendões num grupo de pacientes com hiperuricémia assintomática (AH) e diagnóstico de Pso e APso. Avaliar a concordância inter-observador entre dois médicos com experiência em US na descrição dos achados.
Métodos: Foram incluídos no estudo vinte e um pacientes com AH: 15 com diagnóstico de Pso e 6 com diagnóstico de APso. Foram recolhidos dados laboratoriais (PCR, VHS e uricemia) e foi determinado o score Psoriasis Area Severity Index. Dois médicos com experiência em ultrassonografia, cegos relativamente aos dados clínicos e valores uricemia, realizaram em duas salas separadas, no mesmo dia, os exames US dos joelhos, das articulações tíbio-tarsais e primeiras articulações metatarso-falângicas.
Resultados: Alterações compatíveis com depósitos de MSU foram encontradas em 100% dos pacientes com Pso e APso. Identificaram-se tofos em 7 pacientes (33,33%): 4 com Pso e 3 com APso; e DCS em 8 pacientes (38,10%): 6 com Pso e 2 com APso. No joelho observou-se derrame intra-articular em 16 pacientes (76,19%): 11 com Pso e 5 com APso; tofos em 6 (28,57%): 3 com Pso e 3 com APso; DCS em 6 (28,57%): 4 com Pso e 2 com APso; e focos hiperecogénicos dentro dos tendões e tecidos moles em 11 (52,38%): 8 com Pso e 3 com APso. Na articulação tíbio-talar 4 pacientes (19,05%), todos com Pso tiveram achados US compatíveis com depósitos de MSU (3 com DCS e 1 com derrame intra-articular). A primeira metatarso-falângica foi a única área articular onde foram encontradas erosões, em 13 pacientes (61,90%): 8 com Pso e 5 com APso. O grau de concordância global inter-observador foi 92,44% na Pso e de 95,5% na APso.
Conclusões: Estes dados demonstram que alterações morfoestruturais compatíveis com depósitos de MSU, em pacientes com AH, ocorrem em ambas as estruturas intra e extra-articulares de pacientes com diagnóstico de Pso e APso, e em 100% dos pacientes neste estudo. Apesar disso 33,33% pacientes tiveram tofos e 38,10% tiveram DCS, que são achados US muito específicos para diagnóstico de gota. O grau de concordância inter-observador para o total dos achados US foi 92,44% na Pso e de 95,5% na APso, mas foi muito baixo na identificação de focos hiperecogénicos intra-articulares no joelho e primeira articulação metatarso-falângica (66,67%), achados passíveis de valorização mais subjetiva. A US é uma ferramenta promissora no diagnóstico e tratamento da gota e um bom instrumento para estudar pacientes com AH. No entanto são necessários mais estudos, com amostras de maiores dimensões.
Introduction: Hyperuricemia is a common finding in patients with psoriasis (Pso) and psoriatic arthritis (APso). Ultrasound (US) has been demonstrated to be a valid imaging technique to study musculoskeletal involment in patients with gout. The main ultrasonographic findings related to monosodium urate (MSU) crystal deposition are: tophi, the double contour sign (DCS) and bone erosion. Hyperechoic spots within tendons and soft tissues and synovial effusion have also been described. Objectives: To investigate the presence of US findings compatible with MSU deposits in the hyaline cartilage, joints and tendons in a group of patients with asymptomatic hyperuricemia (AH) and diagnosis of Pso and APso. To assess inter-observer reliability between two experienced sonographer in the description of US findings. Methods: Twenty one patients with AH were included in the study: 16 with diagnosis of Pso and 5 with diagnosis of APso. Laboratory data (CRP, ESR and uricemia) were collected and the Psoriasis Area Severity Index score was determined. Two experienced sonographers, blinded to clinical data and uricemia values, performed in two separated rooms, in the same day, US examinations of the knees, tibiotarsal joints and first metatarsal-phalangeal joints. Results: Changes compatible with MSU deposits were found in 100% of patients with diagnosis of Pso and APso. Tophi were identified in 7 patients (33.33%): 4 with Pso and 3 with APso; and DCS in 8 patients (38.10%): 6 with Pso and 2 with Apso. In the knee we observed synovial effusion in 16 patients (76.19%): 11 with Pso and 5 with APso; tophi in 6 (28.57%): 3 with Pso and 3 with APso; DCS in 6 (28.57%): 4 with Pso and 2 with APso; and hyperechoic spots within the tendons and soft tissues in 11 (52.38%): 8 with Pso and 3 with Apso. In tibiotalar joint 4 patients (19.05%), all with Pso, had US findings compatible with MSU deposits (3 with DCS and 1 with synovial effusion). The first metatarsal-phalangeal was the solely articular area where we found erosions, in 13 patients (61.90%): 8 with Pso and 5 with Apso. The percentage of overall inter-observer agreement was 92.44% in Pso and 95.5% in the APso. Conclusions: These data demonstrate that morphostrutural changes compatible with MSU deposits in patients with AH occur in both intra- and extra-articular structures of patients with a diagnosis of Pso and APso and in 100% of the patients in this study. Nevertheless 33.33% patients have US findings compatible with tophi and 38.10% have DCS, which are very specific US findings for gout diagnosis. The percentage of overall inter-observer agreement was 92.44% in Pso and 95.5% in the APso, to the total of the US findings, but it was very low to the identification of intraarticular hyperechoic spots in the knee and first metatarsal phalangeal joints (66,67%), US findings susceptible of more subjective valuation. US is a promising tool in the diagnosis and management of gout and a good instrument to study patients with AH. However further studies are needed with larger samples.
Introduction: Hyperuricemia is a common finding in patients with psoriasis (Pso) and psoriatic arthritis (APso). Ultrasound (US) has been demonstrated to be a valid imaging technique to study musculoskeletal involment in patients with gout. The main ultrasonographic findings related to monosodium urate (MSU) crystal deposition are: tophi, the double contour sign (DCS) and bone erosion. Hyperechoic spots within tendons and soft tissues and synovial effusion have also been described. Objectives: To investigate the presence of US findings compatible with MSU deposits in the hyaline cartilage, joints and tendons in a group of patients with asymptomatic hyperuricemia (AH) and diagnosis of Pso and APso. To assess inter-observer reliability between two experienced sonographer in the description of US findings. Methods: Twenty one patients with AH were included in the study: 16 with diagnosis of Pso and 5 with diagnosis of APso. Laboratory data (CRP, ESR and uricemia) were collected and the Psoriasis Area Severity Index score was determined. Two experienced sonographers, blinded to clinical data and uricemia values, performed in two separated rooms, in the same day, US examinations of the knees, tibiotarsal joints and first metatarsal-phalangeal joints. Results: Changes compatible with MSU deposits were found in 100% of patients with diagnosis of Pso and APso. Tophi were identified in 7 patients (33.33%): 4 with Pso and 3 with APso; and DCS in 8 patients (38.10%): 6 with Pso and 2 with Apso. In the knee we observed synovial effusion in 16 patients (76.19%): 11 with Pso and 5 with APso; tophi in 6 (28.57%): 3 with Pso and 3 with APso; DCS in 6 (28.57%): 4 with Pso and 2 with APso; and hyperechoic spots within the tendons and soft tissues in 11 (52.38%): 8 with Pso and 3 with Apso. In tibiotalar joint 4 patients (19.05%), all with Pso, had US findings compatible with MSU deposits (3 with DCS and 1 with synovial effusion). The first metatarsal-phalangeal was the solely articular area where we found erosions, in 13 patients (61.90%): 8 with Pso and 5 with Apso. The percentage of overall inter-observer agreement was 92.44% in Pso and 95.5% in the APso. Conclusions: These data demonstrate that morphostrutural changes compatible with MSU deposits in patients with AH occur in both intra- and extra-articular structures of patients with a diagnosis of Pso and APso and in 100% of the patients in this study. Nevertheless 33.33% patients have US findings compatible with tophi and 38.10% have DCS, which are very specific US findings for gout diagnosis. The percentage of overall inter-observer agreement was 92.44% in Pso and 95.5% in the APso, to the total of the US findings, but it was very low to the identification of intraarticular hyperechoic spots in the knee and first metatarsal phalangeal joints (66,67%), US findings susceptible of more subjective valuation. US is a promising tool in the diagnosis and management of gout and a good instrument to study patients with AH. However further studies are needed with larger samples.
Description
Keywords
Artrite Psoriática Hiperuricémia Assintomática Psoríase Ultrassonografia