Background Musculoskeletal ultrasound can be now considered a complement to physical examination in rheumatoid arthritis. This study evaluates the role of musculoskeletal ultrasound in assessment of rheumatoid hand function and underlying functional defects and disabilities in order to find out a possibly better tool for assessment. Results Hand grip weakness was significantly associated with metacarpophalangeal joints synovitis of ulnar 4 fingers (p = 0.045), wrist joint synovitis (p = 0.009), flexor tendons tenosynovitis of the ulnar 4 fingers (p = 0.001), flexor pollicis longus tendon tenosynovitis (p = 0.013). Hand function impairment by grip ability test was significantly associated with metacarpophalangeal joints synovitis of ulnar 4 fingers (p = 0.009), wrist joint synovitis (p = 0.004), and flexor tendons tenosynovitis of the ulnar 4 fingers (p = 0.042). Multiple linear regression analysis showed that the most influencing factor affecting grip ability test and hand grip strength was ulnar 4 Flexor tendons tenosynovitis (P = 0.023, P = 0.037) respectively. Conclusions Joint synovitis and tenosynovitis that are detected by musculoskeletal ultrasound can be used as an assessment tool for hand function in rheumatoid arthritis, since they are associated with reduced hand grip strength and impaired hand ability.
BackgroundMacrophage activation syndrome (MAS) is a complication of JIA which elevates morbidity and mortality. Early recognition, differentiation from activity of JIA itself and the subsequent introduction of aggressive treatment contributes to better prognosis.ObjectivesA retrograde study to investigate the occurrence of missed MAS among JIA patients to assess the extent of the problem among those patients.MethodsThe study included 100 JIA patients registered in paediatric departments over 2 years in urban areas of Cairo. All JIA subtypes where included. MAS was diagnosed according to preliminary diagnostic guidelines for MAS complicating sJIA.Ravelli et al., 2005) JIA patients who had history of recent infection, hepatitis or other liver disease, malignancy and pancytopenia were excluded. The hospital registry for JIA patients was scanned for medical history with special attention for records of history suggestive of MAS, Clinical examination, Laboratory investigations and radiological data. Complementary investigations were done when needed.ResultsAmong the studied 100 JIA patients, 14% of patients fulfilled the criteria and were diagnosed awith MAS. Mortality rate was 2% of all JIA patients and 14% of JIA cases with MAS. Regarding gender, there were 10 females (71%) and 4 males (35%). Their age ranged from 3.5 to 18 years old (median 8 years). The disease duration ranged from 0.1 to 6 years (median 1.5 years). Ferritin level was elevated in all MAS patients. Renal affection was present in 10 MAS patients (71%) in the form of elevated serum creatinine level, In contrast to uncomplicated JIA where there was no significant renal involvement.Table 1Frequency of clinical manifestations of MAS among the studied patientsClinical manifestationsJIA with MAS(n=14)JIA without MAS(n=86) Fever14 (100%)2 (2.3%)Central nervous system manifestations3 (21%)-Haemorrhage1 (7.1%)-Hepatomegaly9 (64%)3 (3.4)%Splenomegaly6 (42%)1 (1.1%)Generalised lymphadenopathy5 (35%)-Cardiovascular system manifestations1 (7.1%)7 (8.1%)Table 2Laboratory results among studied patientsParameterJIA with MASJIA without MAS Mean±SD R red blood cells (106/mm3)3.4±0.64.66±0.73Haemoglobin(gm/dl)9.04±1.3911.8±1.87Platelets (103/mm3)124.29±85.8299±90.053WBCS (103/mm3)6361.43±3937.711989.6±6056.3Aaspartate transaminase(u/l)90.14±93.129.5±23.084Creatinine (mg/dl)2.19±0.910.73±0.2International normalised ratio2.04±0.61.07±0.14Fibrinogen(mg/L)203.5±86.02317.86±67.39Eerythrocyte sedimentation rate(mm/h)28.29±13.1217.56±2.83C – reactive protein(mg/dl)60.71±52.217.49±7.48ConclusionsMAS is a potentially fulminant disorder whose incidence has increased due to raised manifestations awareness. It may be a complication of any JIA subtype but primarily systemic onset subtype. The diagnosis of MAS should be considered in presence of continuous fever, CNS, renal or haemorrhagic manifestation in JIA.Reference[1] Ravelli A, Magni-Manzoni S, Pistorio A, Besana C, Foti T, Ruperto N, Viola S, Martini A. (2005): Preliminary diagnostic guidelines for macrophage activation syndr...
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