Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Abstract Swanson silastic arthroplasty, introduced by Alfred Swanson in the late sixties, has long been the treatment of choice for metacarpophalangeal (MCP) arthroplasty in cases of rheumatoid arthritis. Silastic implant arthroplasty has a significant role in the reconstruction of eroded MCP joints, but the method does not recreate a normal MCP joint. The Sutter implant has been designed to improve the function of the MCP joint, and especially to reduce the extension deficit. There are numerous studies concerning the Swanson implant, but limited number of previous articles on the use of the Sutter implant. The aim of this thesis was to determine the outcome of MCP arthroplasty with the Sutter implant in patients with inflammatory joint disease. This thesis is based on two studies concerning Sutter implant arthroplasty in patients with advanced rheumatoid arthritis. One of these was a prospective study performed at Oulu University Hospital in which patients were randomised into Swanson and Sutter implant groups representing 49 hands and 174 implants, with a mean follow up time of 4.8 years, and the other was a prospective study performed at the Rheumatism Foundation Hospital in Heinola in which Sutter implant arthroplasty was carried out on 117 hands employing 350 implants, with a mean follow-up time of 5.3 years. The main results were that arthroplasty yields similar results with both of these implants with respect to clinical parameters such as range of motion, ulnar deviation, grip strength and pain. Furthermore, the revision rate in our Sutter follow-up study was high, and survival, with revision surgery as the end point, was poor. We created a new radiographic grading system for bone resorption, i.e. osteolysis, in MCP arthroplasty and found this to be more severe after Sutter than Swanson implant arthroplasty, for some unknown reason. Moreover, we found that osteolysis was symptom-free but related to implant fractures. As a conclusion silicone implant arthroplasty should be used only with rheumatoid patients with advanced destruction. High implant fracture rates and high amounts of osteolytic changes in radiographs are not favourable for the use of the Sutter implant. If continuous development of new prostheses achieves implant with as good clinical outcome and reasonable costs as Swanson implant, the use of the silicone implants will be questionable.

In this longitudinal pilot study, magnetic resonance imaging (MRI) and Early Erosions in Rheumatoid Arthritis (EERA) software were used to quantify bone erosive damage in the metacarpophalangeal (MCP) 2-5 joints of the worst-affected hand (i.e. greatest swelling and tenderness at baseline) of patients with rheumatoid arthritis (n=35). Firstly, Spearman’s rho (rs) was used to evaluate the correlation between total change in sum erosive damage and change in functional ability, as well as the correlation between rate of change in sum erosive damage and change in functional ability. The rs (p-value) for total change and rate of change in sum erosive damage was 0.099 (0.585) and 0.104 (0.565), respectively. Therefore, the null hypothesis that neither variable was associated with change in functional ability could not be rejected. Participants were also classified into three groups based on total change in sum erosive damage (improvement, stable or progression) and were examined for possible differences in a variety of measures using an exploratory, non-statistical approach. Most notably, participants in the improvement group had more than five times the mean sum erosive damage at baseline compared to the progression group and also appeared to be the least aggresively medicated of the three cohorts. This study is the first to apply EERA in a way that helps to address clinically important questions related to change in erosive damage and functional ability. Future studies should use the ideas and concepts generated in this pilot study to further explore the use of this highly reproducible erosion quantification software, with the ultimate goal of expanding the applications of EERA in both the research and clinical settings. / Thesis / Master of Science (MSc) / In this study, the hands of patients with rheumatoid arthritis (RA) were assessed using magnetic resonance imaging (MRI) to investigate how erosive damage to the bone changes over time. Specialized computer software entitled Early Erosions in Rheumatoid Arthritis (EERA) was used to perform this analysis. Firstly, change in erosive damage was not found to be related to change in functional ability (e.g. eating, grip, etc.). Secondly, it appeared that individuals who demonstrated improvement in bone damage over time had significant damage at the beginning of the study period. Overall, this study provides new information for researchers and clinicians in terms of how this unique software can be used to enhance our understanding of RA. Future studies will continue to explore ways in which this software can be applied to address questions that are important to RA patients.

Visou-se neste estudo criar uma forma de qualidade preditiva, buscando uma padronização das estruturas que compõem a articulação metacarpofalangeana, através do método de corte pós-congelamento e mensuração das estruturas nas medidas de espessura e largura. Então através da análise estatística foi possível gerar esse padrão para as seguintes estruturas: tendão flexor digital superficial, tendão flexor digital profundo, cápsula articular, ligamento extensor, ligamento intersesamoideo e ainda correlacionar os valores obtidos, visando agora à interligação de estruturas em seu estado de normalidade, para que pudesse ser aplicado em situações de injúrias. Dentro das estruturas analisadas a que mais apresentou variações foi a cápsula articular, talvez pela falta de padronização no momento da coleta (idade, função, histórico clínico). No caso da correlação não foi possível chegar a valores significativos, uma vez que a correlação apresentou-se baixa para a maioria das estruturas. / This study, try to create a predicative quality, looking for a pattern for the structures that compose the metacarpophalangeal joint, using the method of cutting after freezing and making the measures of the structures in denseness and largeness. Then through the statistics analysis it was possible to create the pattern to the following structures: superficial digital flexor tendon, deep digital flexor tendon, articular capsule, extensor ligaments, intersesamoids ligaments and still make the correlation with the numbers that was found, trying to get the interconnect of the structures in the normal position, to be used in injuries situations. The articular capsule was the structure that shows the highest variation, maybe because there was not a pattern at the moment of collecting (age, function, clinical historical). In the correlation it was not possible to find significant values, once the correlation was low to the majority of structures.

Visou-se neste estudo criar uma forma de qualidade preditiva, buscando uma padronização das estruturas que compõem a articulação metacarpofalangeana, através do método de corte pós-congelamento e mensuração das estruturas nas medidas de espessura e largura. Então através da análise estatística foi possível gerar esse padrão para as seguintes estruturas: tendão flexor digital superficial, tendão flexor digital profundo, cápsula articular, ligamento extensor, ligamento intersesamoideo e ainda correlacionar os valores obtidos, visando agora à interligação de estruturas em seu estado de normalidade, para que pudesse ser aplicado em situações de injúrias. Dentro das estruturas analisadas a que mais apresentou variações foi a cápsula articular, talvez pela falta de padronização no momento da coleta (idade, função, histórico clínico). No caso da correlação não foi possível chegar a valores significativos, uma vez que a correlação apresentou-se baixa para a maioria das estruturas. / This study, try to create a predicative quality, looking for a pattern for the structures that compose the metacarpophalangeal joint, using the method of cutting after freezing and making the measures of the structures in denseness and largeness. Then through the statistics analysis it was possible to create the pattern to the following structures: superficial digital flexor tendon, deep digital flexor tendon, articular capsule, extensor ligaments, intersesamoids ligaments and still make the correlation with the numbers that was found, trying to get the interconnect of the structures in the normal position, to be used in injuries situations. The articular capsule was the structure that shows the highest variation, maybe because there was not a pattern at the moment of collecting (age, function, clinical historical). In the correlation it was not possible to find significant values, once the correlation was low to the majority of structures.

In order to assess and establish the association between ultrasonographic and anatomophatological findings, ultrasonographic examinations were performed, post mortem, on the fetlock and associated structures of 37 equine forelimb specimens. All this specimens showed abnormal images or images identified as suspicious on the ultrasound examination. Subsequently, these limbs were dissected and underwent an anatomopathogical study. The association between ultrasonographic and anatomopathological findings was established by comparing data obtained by both methods. Ultrasonographic changes in size, shape, architecture and echogenicity of ligaments, tendons, joint capsule, articular cartilage and bony surfaces of the metacarpophalangeal joint were associated with the anatomopathological findings. / O objetivo deste estudo foi avaliar e estabelecer a relação entre achados ultrassonográficos e alterações anatomopatológicas que contribuíssem para o diagnóstico das lesões da articulação metacarpofalangeana equina e suas estruturas correspondentes. Setenta membros torácicos equinos, obtidos em instalações frigoríficas, foram submetidos a exame ultrassonográfico post mortem. Destes, 37 apresentaram imagens ultrassonográficas consideradas suspeitas ou anormais quando comparadas às imagens normais utilizadas como controle. Posteriormente foi realizada a dissecação dos mesmos e o estudo anatomatológico. A relação entre ambos foi estabelecida através da combinação das imagens ultrassonográficas e os achados das análises macroscópica e microscópicas. As alterações de tamanho, forma, arquitetura e ecogenicidade das estruturas ligamentosas, tendinosas, cápsula articular e superfícies ósseas da articulação metacarpo-falangeana observadas nas imagens ecográficas corresponderam a achados anatomopatógicos anormais.