Questions of instrumental diagnosis of reactive arthritis
Educational Establishment «Vitebsk State Order of Peoples’ Friendship Medical University», Vitebsk, Republic of Belarus
Vestnik VGMU. 2016;15(4):33-39.
Objectives. To study the characteristics and nature of the joints lesions in patients with reactive arthritis using magnetic resonance imaging (MRI) and ultrasonography (USG) of the joints, to assess their informativeness.
Material and methods. We examined 56 patients with ReA, whose average age was 34 years (31-42), and whose median duration of arthritis made up 1 year (from 0,3 to 3,25). All patients underwent comprehensive clinical, laboratory and instrumental examination. The study of the inflamed joints included MRI in the Т1W, Т2W, STIR modes, multiple-scale dynamic ultrasound examination in B-mode and X-ray examination.
Results. When performing MRI of the affected joints the inflamed entheses (thickening, microfractured fibers, the appearance of the sites of the decreased and increased density), the presence beneath them of local osteitis and erosive defect of the vertebral end bone plate were clearly visualized. When conducting ultrasound investigation of the inflamed joint nonlinear boundary defect of the cortical bone layer with a hyperechogenic contour in the places of the inflamed enthesis fixation with reduced echogenicity due to the acute inflammation with unechogenic areas – microtears was determined. Articular surface of the bones in the places of the synovial fixation was with a clearly hyperechogenic, smooth contour, and the synovium without any pathological vascularization and focal thickening. When conducting the research in all affected joints of the patients with this pathology we revealed positive «pain test» under ultrasound control.
Conclusions. We have found that ultrasound is not inferior to MRI with regard to its informativeness in the assessment of the nature and extent of the pathological process in the tendinous-ligamentous apparatus and tissues surrounding the joints. Ultrasonic criteria of the joints lesions in ReA are: enthesitis, osteitis of the vertebral end plate of the bone under the inflamed enthesis, inflammation erosions in the places of the inflamed entheses insertion, paraentheseal edema and / or exudation, positive «pain test» on palpation of the affected enthesis under ultrasound control.
Key words: reactive arthritis, enthesitis, osteitis, erosion.
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Information about authors:
Sirotka V.V. – Candidate of Medical Sciences, associate professor of the Chair of Internal Medicine No. 1, Educational Establishment «Vitebsk State Order of Peoples’ Friendship Medical University».