粘连相关关节炎胸锁关节受累的超声成像:近距离观察关节囊粘连炎。

IF 0.8 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Fiammetta Zunica, Martina Loiodice, Francesca Riccaboni, Patrizia Carlucci, Gian Vincenzo Zuccotti, Vincenzo Ricci
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引用次数: 0

摘要

简介关节内膜炎相关性关节炎是幼年特发性关节炎的一种特殊亚型,其特点是关节炎和关节内膜炎同时存在,或其中一种关节炎的证据与骶髂关节触痛、炎性背痛、人类白细胞抗原-B27的存在、急性无症状前葡萄膜炎、6岁或6岁以上男性儿童发病或一级亲属有脊柱关节病史中的至少两种同时存在。胸锁关节等小关节很少受累,相关文献对其受累于粘连炎相关关节炎的发病率评估不足:作者报告了一个患有幼年特发性关节炎的 12 岁男童左侧胸锁关节炎/粘连炎的非典型病例。B型超声波检查发现关节积液、滑膜肥厚和关节囊隆起,再加上胸锁关节的彩色多普勒微血管图,对优化临床实践中的药物治疗方法至关重要。从这个意义上说,超声波检查是体格检查的自然延伸,可准确界定一线药物对疾病活动控制不佳的情况:讨论:本病例报告可被视为首次准确报告一名与关节粘连相关的关节炎患者胸锁关节病变的 B 型和彩色多普勒检查结果。超声成像显示关节内积液、关节囊膨出和滑膜肥厚,明确定义了胸锁关节炎。有趣的是,滑膜组织和关节囊-骨界面(即关节囊内膜)都出现了血管增生,这表明胸锁关节炎相关性关节炎患者可能同时患有关节炎和内膜炎:结论:高分辨率护理点超声波似乎是儿科领域潜在的 "游戏规则改变者",可及时优化对粘连相关关节炎患者的药物治疗。事实上,与磁共振成像等其他成像方式不同,现代高频超声换能器能保证浅关节的超高空间分辨率,并能准确绘制滑膜和关节囊组织中的小尺寸、低流量血管,从而优化疾病活动分级,避免使用造影剂。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ultrasound imaging for sternoclavicular joint involvement in enthesitis-related arthritis: A closer look at capsular enthesitis.

Introduction: Enthesitis-related arthritis is a specific subtype of juvenile idiopathic arthritis characterised by the co-presence of arthritis and enthesitis or the evidence of one of them coupled with at least two among sacroiliac joint tenderness, inflammatory back pain, presence of human leukocyte antigen-B27, acute symptomatic anterior uveitis, onset in a male child aged 6 years or older or history of spondyloarthropathy in a first-degree relative. Small joints like the sternoclavicular joint are rarely affected, and the prevalence of their involvement in enthesitis-related arthritis has been poorly assessed in the pertinent literature.

Case report: The authors report an atypical case of left sternoclavicular joint arthritis/enthesitis in a 12-year-old male child with juvenile idiopathic arthritis. The B-mode sonographic findings of articular effusion, synovial hypertrophy and capsular bulging, coupled with the microvascular mapping with colour Doppler of the sternoclavicular joint, have been crucial to optimising the pharmacological approach in clinical practice. In this sense, the sonographic examination presented as a natural extension of the physical examination to accurately define the poor control of disease activity using first-line pharmacological agents.

Discussion: The present case report can be considered the first to accurately report the B-mode and the colour Doppler findings of a pathological sternoclavicular joint in a patient enthesitis-related arthritis. Ultrasound imaging demonstrated intra-articular effusion, capsular bulging and synovial hypertrophy clearly defining sternoclavicular joint arthritis. Interestingly, the hypervascularisation involved both the synovial tissue and the capsule-bone interface - that is, the enthesis of the joint capsule - suggesting a potential co-existence of arthritis and enthesitis of the sternoclavicular joint in enthesitis-related arthritis patients.

Conclusion: The high-resolution point-of-care ultrasound seems to be a potential 'game changer' in paediatrics to promptly optimise the pharmacological management in enthesitis-related arthritis patients. Indeed, unlike other imaging modalities such as magnetic resonance imaging, modern high-frequency ultrasound transducers guarantee a superior spatial resolution of superficial joints and allow an accurate mapping of small-size and low-flow vascular elements of synovial and capsular tissues optimising the grading of disease activity and avoiding the use of contrast agent.

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来源期刊
Ultrasound
Ultrasound RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
1.70
自引率
0.00%
发文量
55
期刊介绍: Ultrasound is the official journal of the British Medical Ultrasound Society (BMUS), a multidisciplinary, charitable society comprising radiologists, obstetricians, sonographers, physicists and veterinarians amongst others.
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