Ahmet Boyacı, Nurefşan Boyacı, Alparslan Yetişgin, Ahmet Tutoğlu, Dilek Şen DOKUMACI

Romatoid artritli hastalarda elde oluşan nörovasküler komplikasyonların B mod ve renkli doppler ultrasonografi ile değerlendirilmesi

Amaç: Romatoid artrite (RA) bağlı olarak el bileğinde oluşan kas iskelet sistemi hastalıklarını ultrasonografi ile tespit etmek ve RA'lı hastalarda arteryel dopplerdeki kan akım patern değişikliklerini saptamak amaçlanmıştır. Materyal ve metod: Amerikan Romatizma Birliği (ACR) kriterlerine göre RAtanısı koyulmuş 35 hasta (70 el bileği) ve kontrol grubu olarak 20 sağlıklı gönüllü (40 el bileği) çalışmaya alındı. Median sinir kesit alanı (MSA), anteroposterior (AP) ve transvers çaplar, karpal tünel girişi [proksimal (p)] ve bilek kıvrımı [distal (d)] düzeylerinde ölçüldü. Karpal tünel girişi düzeyinde fleksör retinakulum kalınlığı değerlendirildi. Renkli Doppler ultrason incelemesinde her iki el nötral pozisyonda iken radial ve ulnar arterler yüksek rezolüsyonlu 12 MHz transduser (Logic 7) ile değerlendirildi. Bulgular: Gruplar arası karşılaştırmada RA grubunda, kontrol grubuna göre AP-p ve AP-d çaplar anlamlı olarak daha küçük bulundu (p<0,05). RAgrubunda radial arter akım hızı ve pik sistolik hızda anlamlı azalma bulundu (p<0,05). Diğer B mod ve doppler ultrasonografi ölçümlerinde gruplar arası anlamlı fark yoktu (p>0,05). Sonuç: KTS klinik bulgu ve semptomu olmayan orta hastalık aktivitesine sahip RA'lı hastalarda sağlıklı kontrollere göre MSA sonuçları benzerdir. Kronik inflamasyona bağlı olarak median sinirin vazomotor fonksiyonlarındaki bozukluk radial kan akımındaki azalmayı açıklayabilir.

Anahtar Kelimeler:

Romatoid Artrit, Median Sinir, Ultrasonografi

Assessment Of Mean Platelet Volume In Patients With Severe ObEvaluation of neurovascular complications of hand by B-mode and color Doppler ultrasonography in patients with rheumatoid arthritis structive Sleep Apnea

Objective: The aim of the study is to detect the musculoskeletal diseases of the wrist depending on rheumatoid arthritis (RA) by ultrasound and to determine changes in arterial Doppler blood flow patterns in patients with RA. Materials and Methods: 35 patients (70 wrists) with a diagnosis of RA according to the American College of Rheumatology criteria and a control group of 20 healthy volunteers (40 wrists) were enrolled in the study. The median nerve cross-sectional area (MSA), anteroposterior (AP), and transverse diameters at the levels of carpal tunnel entrance [proximal (p)] and wrist bend [distal (d)] were measured. The flexor retinaculum thickness was evaluated at the level of carpal tunnel entrance. In the color Doppler ultrasound examination, radial and ulnar arteries were evaluated with high resolution 12 MHz transducer (Logic 7) while both hands were in a neutral position. Results: In comparison between the groups, AP-p and AP-d diameters were significantly smaller in the RA group than in the control group (p<0.05). The radial artery flow velocity and peak systolic velocity were significantly decreased in the RAgroup (p<0.05). There was no significant difference between the groups in other B-mode and Doppler ultrasonography measurements (p>0.05). Conclusion: RA patients with moderate disease activity and without clinical signs and symptoms of CTS have similar MSA results compared to healthy controls. The vasomotor function disorder depending on the chronic inflammation in median nerve may explain the reduction of radial blood flow.

Keywords:

Rheumatoid Arthritis, Median Nerve, Ultrasonography,

PDF

___

1.Galarza-Delgado DA, Esquivel-Valerio JA, GarzaElizondo MA, Gongora-Rivera F, Munoz-De Hoyos JL, Serna-Pena G. Carotid atherosclerosis in patients with rheumatoid arthritis and rheumatoid nodules. Reumatol Clin. 2013;9(3):136-41.
2.Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340(2):115- 26.
3.Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of infl amma tory a rthritis. Ann Rheum Dis. 2010;69(2):325-31.
4.Bresnihan B. Arthritis and muscle weakness or neuropathy. In Klippel JH, Dieppe PA eds. Second edition. Rheumatology. London, Philadelphia, St. Luis, Sidney, Tokyo, 1988: 2.4.5.
5.Chang DJ, Paget SA. Neurologic complications of rheumatoid arthritis. Rheum Dis Clin North Am. 1993;19(4):955-73.
6.Ozcan HN, Kara M, Ozcan F, Bostanoglu S, Karademir MA, Erkin G, et al. Dynamic Doppler evaluation of the radial and ulnar arteries in patients with carpal tunnel syndrome. AJR Am J Roentgenol. 2011;197(5):W817-20.
7.Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-24.
8.Hammer HB, Haavardsholm EA, Kvien TK. Ultrasonographic measurement of the median nerve in patients with rheumatoid arthritis without symptoms or signs of carpal tunnel syndrome. Ann Rheum Dis. 2007;66(6):825- 7.
9.Ali SN, Srivastava S. Study of ulnar and radial arteries at wrist level in smokers. Scand J Plast Reconstr Surg Hand Surg. 2008;42(6):320-4.
10.Wilder-Smith EP, FookChong S, Chew SE, Chow A, Guo Y. Vasomotor dysfunction in carpal tunnel syndrome. Muscle Nerve. 2003;28(5):582-6.
11.Lundborg G. Ischemic nerve injury. Experimental studies on intraneural microvascular pathophysiology and nerve function in a limb subjected to temporary circulatory arrest. Scand J Plast Reconstr Surg Suppl. 1970;6:3-113.
12.McQueen FM, Ostergaard M. Established rheumatoid arthritis - new imaging modalities. Best Pract Res Clin Rheumatol. 2007;21(5):841- 56.
13.Karadag O, Kalyoncu U, Akdogan A, Karadag YS, Bilgen SA, Ozbakir S, et al. Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: prevalence and correlation with disease activity. Rheumatol Int. 2012;32(8):2313-9.