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Previous issue date: 2016-12-09 / Introduction: Ultrasonography (US) is an useful tool for evaluation of synovial vascularization and proliferation in rheumatoid arthritis (RA). Differently from US power Doppler (PD), the resistive index (RI) of spectral Doppler (SD) provides a quantitative analysis of vascular inflammation, but its utility in the ultrasonographic evaluation of RA activity has not been established. Objetives: To associate the RI with US parameters of synovitis and disease activity in patients with established RA. Methods: Consecutive pD-positive RA patients were included in a prospective cross-sectional study. Disease activity and disability were evaluated using the Disease Activity Score in 28-joints (DAS28) and Health Assessment Questionnaire (HAQ), respectively. Gray scale (GS) synovitis, PD and SD analysis were performed by one of two examiners in wrists, second and third metacarpophalangeal, and proximal interphalangeal joints. The 10 joint-GS and -PD scores and the mean RI were then calculated. Weighted kappa values were employed to assess interobserver reliability. Results: out of 112 patients scanned initially, 95 patients with PD signal were included (median duration of disease, 7 years and mean DAS28, 4.32 ? 1.66). Weighted kappa values in real-time US were 0.77 for synovitis, 0.87 for PD and 0.68 for RI. There was a significant association of 10 joint-GS and -PD with swollen joints count (rs = 0.54, p <0.001 and rs = 0.39, P <0.001, respectively). There were no significant correlations of the RI with 10-joint- GS, 10-joint-PD, DAS28, joint counts or HAQ (P>0.10 for all tests). Conclusion: Spectral Doppler RI did not correlate to any US or clinical parameters of disease activity in our sample of established RA patients. The addition of the RI score does not seem to improve US performance in this scenario. / Introdu??o: A ultrassonografia (US) ? uma ferramenta ?til para a avalia??o da vasculariza??o sinovial e prolifera??o na artrite reumatoide (AR). Diferentemente do sinal de power Doppler (PD), o ?ndice de resist?ncia (RI) do Doppler espectral(SD) fornece uma an?lise quantitativa de inflama??o vascular, mas a sua utilidade na avalia??o ultrassonogr?fica da atividade reumatoide n?o foi estabelecida. Objetivos: Associar o RI com par?metros ultrassonogr?ficos e ?ndices de atividade da doen?a em pacientes com AR estabelecida. M?todos: pacientes com AR PDpositivos, consecutivos, foram inclu?dos neste estudo transversal. A atividade da doen?a e a capacidade funcional foram avaliados usando o Disease Activity Score em 28 articula??es (DAS28) e Health Assessment Questionnaire (HAQ), respectivamente. Sinovite em escala de cinza (GS), PD e an?lise do SD foram realizadas por dois examinadores em punhos, segunda e terceira metacarpofalangeanas e articula??es interfalangianas proximais. Os escores 10 GS, escore10 PD e media do RI foram calculados. Os valores de kappa ponderado foram empregados para avaliar a correla??o interobservador. Resultados: dos 112 pacientes recrutados inicialmente, 95 pacientes com sinal PD foram inclu?dos (dura??o m?dia da doen?a: 7 anos; DAS28 m?dio: 4,32 ? 1,66). Os valores de kappa em tempo real US foram 0,77 para sinovite, 0,87 para PD e de 0,68 para RI. Houve associa??o significativa dos escores 10 PD e 10 GS com a contagem de articula??es edemaciadas (rS=0.54, P<0.001 e rS=0.39, P<0.001, respectivamente). N?o foram obtidas correla??es significativas entre RI e escore 10 GS, escore 10
PD, DAS28 ou HAQ (P> 0,10 para todos os testes). Conclus?o: o RI n?o se correlacionou com dados ultrassonogr?ficos ou par?metros cl?nicos de atividade da doen?a em nossos pacientes com AR estabelecida. A adi??o do RI n?o pareceu melhorar o desempenho da US neste cen?rio.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/7289 |
| Date | 09 December 2016 |
| Creators | Bisi, Melissa Cl?udia |
| Contributors | Staub, Henrique Luiz, Mendon?a, Jos? Alexandre |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Escola de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 600, 600, 600, -224747486637135387, -969369452308786627 |
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