A.M. EROL, E. CECELİ, P. BOZMAN, S. RAMADAN UYSAL

Romatoid elin duyusal değerlendirmesi ve manyetik rezonans görüntüleme bulguları ile ilişkisi

Amaç: Bu çalışmanın amacı, romatoid artritte (RA) elin duyusal durumunu değerlendirmek ve manyetik rezonans görüntüleme (MRG) bulguları arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntem: Çalışmaya 33 RA tanısı almış hasta ve 33 sağlıklı kontrol grubu dahil edildi. Her iki grupta ağrı, sıcak-soğuk, dokunma, pozisyon, vibrasyon ve iki nokta diskriminasyon duyuları değerlendirildi. RA grubunda dominant el MRG çekimi yapıldı. Sinovit, tenosinovit, kemik erozyonu ve kemik ödemi OMERACT RA-MRG sistemine göre sınıflandırıldı. Bulgular: Ağrı, dokunma, sıcak-soğuk ve pozisyon duyuları RA grubunda normal olarak bulundu. Tüm hastalar vibrasyon duyusunu doğru lokalize etmesine rağmen, %60.6sı vibrasyon duyusu şiddetinde azalma olduğunu ifade etti. İki nokta diskriminasyon değerleri RA grubunda, anlamlı düzeyde yüksek bulundu (p

Sensory examination of rheumatoid hand and the relationship with magnetic resonance imaging findings

Aim: The aim of this study was to evaluate the effect of rheumatoid arthritis (RA) on the sensory status of the hand and to determine the relationship with magnetic resonance imaging (MRI) findings. Materials and Methods: Thirty-three RA patients and controls were included in the study. Pain, hot-cold, touch, position, vibration and two point discrimination senses were evaluated in both groups. An MRI of the dominant hand was obtained in the RA group. Synovitis, tenosynovitis, bone erosion and edema were evaluated according to the OMERACT RA-MRI scoring system. Results: Pain, hot-cold, touch and position senses were normal in the RA group. Although vibration was correctly localised by all patients, 60.6% defined a decrease in intensity of vibration. Two point discrimination values were significantly higher in the RA group (p<0.001). Tenosynovitis and synovitis scores were higher in patients who described a decrease in the intensity of vibration (respectively p<0.001, p<0.05). There was a positive correlation between the two point discrimination values at the dorsal phalanx, dorsum of hand, thenar and distal palmar regions and tenosynovitis scores (p<0.05). Conclusion: In our study vibration and two point discrimination were impaired in the RA group. This can be related to nervous system involvement which can be seen in RA as an extra-articular symptom. Additionally proinflammatory cytokines which are produced by tenosynovium can affect mechanoreceptors located in the myotendinous junction leading to sensory disturbances. Hence, a detailed neurological examination is very important in RA. Furthermore, since tenosynovitis is a common pathology in RA, an MRI can be used as a supportive method in diagnosis, treatment and follow up.

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