BackgroundExertional leg pain and Achilles enthesitis are two musculoskleletal manifestations which have been described in familial Mediterranean fever (FMF) patients. Muscle performance is related both with mass and architecture. Measurements of muscle thickness and pennation angle in muscles with pennate structure, such as gastrocnemius, are representative of muscle mass and architecture, both of which can easily be measured via musculoskeletal ultrasound.ObjectivesAim of this study is to evaluate thickness and pennation angle of medial gastrocnemius via ultrasound to evaluate muscle structure in FMF patients in order to detect implications of altered muscle condition and search for any relations with exertional leg pain/Achilles enthesitis. To our best knowledge this is the first study on the subject.MethodsConsecutive FMF patients meeting Tel-Hashomer criteria between the ages of 18-65 were enrolled. A control group was formed from healthy volunteers with similar demographics. All ultrasound evaluations were performed by the same observer. Thickness and pennation angle of medial gastrocnemius was measured. Achilles tendon findings were scored according to OMERACT suggestions and total inflammation and structural damage scores recorded.ResultsA total of 40 FMF patients and 17 controls were enrolled. Clinical characteristics and ultrasound findings of subjects were presented in Table 1. All FMF patients were under colchicine treatment and 10% was also under anti-interleukin 1 treatment. Demographics were similar between groups. Right gastrocnemius pennation angle was significantly reduced in FMF group (degree, median(IQR): 20.8 (3.6) vs 22.7 (4.5), p=0.048). OMERACT ultrasound inflammation total scores were incresed on both sides in FMF group. When gastrocnemius and enthesis ultrasound findings were compared between FMF patients with and without exertional myalgia, no significant differences were observed. When FMF patients with and without enthesis findings in ultrasound examination were compared, again no significant differences in pennation angles and muscle thicknesses were observed.Table 1.Clinical characteristics and ultrasound findings in subjectsFMF groupControl grouppN =40N=17Age, years, median (IQR)42.8 (23.0)38.0 (15.0)0.447Gender, female, number (%)29 (72.5)10 (58.8)0.310BMI, median (IQR)24.6 (5.3)24.8 (5.7)0.485Presence of exertional myalgia, number (%)22 (55)Gastrocnemius thickness, mm, median (IQR) Right19.7 (2.9)20.7 (5.6)0.303 Left19.6 (2.7)20.7 (4.6)0.321Gastrocnemius pennation angle, degrees, median (IQR) Right20.8 (3.6)22.7 (4.5)0.048 Left21.0 (3.3)21.8 (4.7)0.417OMERACT ultrasound tissue damage total score, median (IQR) Right2.0 (2.0)2.0 (2.0)0.659 Left2.0 (2.0)2.0 (2.0)0.280OMERACT ultrasound inflammation total score, median (IQR) Right0 (2.0)0 (0)0.005 Left0 (2.0)0 (0)0.023ConclusionOur preliminary results imply altered right gastrocnemius structure in FMF patients regardless of Achilles tendon involvement and exertional myalgia, which may imply altered muscle function. By increasing the number of subjects we plan to achieve more accurate results.References[1]Eshed I, et al. Exertional leg pain as a manifestation of occult spondyloarthropathy in familial Mediterranean fever: an MRI evaluation. Scand J Rheumatol. 2012;41:482-486.[2]Kawakami Y, et al. Muscle-fiber pennation angles are greater in hypertrophied than in normal muscles. J Appl Physiol (1985). 1993;74:2740-2744.[3]Filippucci E, et al. Reliability of high-resolution ultrasonography in the assessment of Achilles tendon enthesopathy in seronegative spondyloarthropathies. Ann Rheum Dis. 2009;68:1850-1855.AcknowledgementsI have no acknowledgements to declare.Disclosure of InterestsNone declared
BackgroundPrimary Sjogren syndrome (pSS) is a chronic autoimmune disease that mainly affects the exocrine glands [1]. Type 2 diabetes mellitus (DM) is also autoimmune disease involving not only the pancreas but also salivary glands. In both diseases, sicca symptoms due to different mechanisms were common [1, 2]. The use of salivary gland ultrasonography (SGUS) has become widespread in the diagnosis and follow-up of pSS [3, 4]. In DM, fewer US-based studies have shown abnormalities in the major salivary glands [2].ObjectivesThis study aimed to compare the SGUS findings in patients with pSS and DM patients with sicca symptoms and to examine the relationship between these findings with clinical and laboratory parameters.MethodsIn this study, 32 patients with pSS and 28 DM patients with sicca symptoms (not meet ACR/EULAR pSS criteria) were included. Demographic data and patient characteristics were obtained from medical records. Physical examination was assessed by a rheumatologist. In all patients, bilateral parotid and submandibular gland US was performed by a blind another rheumatologist, using the Hocevar and the Outcome Measures in Rheumatology (OMERACT) scoring system. Clinic and ultrasonographic variables were compared between groups. The association between SGUS score and disease duration was analyzed by correlation analysis.ResultsPatients with pSS presented higher SGUS scores than patients with DM significantly (the Hocevar total score; 20.93(±9.65) vs 3.82(±3.71); p<0.05, the OMERACT total score; 5.96(±2.30) vs 2.07(±1.65); p<0.05, respectively). In patients with pSS, the submandibular gland scores higher than the parotid gland scores while in patients with DM showed higher parotid gland scores. Other demographic data is shown in Table 1. In pSS patients, the Hocevar and the OMERACT total SGUS scores were significantly correlated with disease duration (r=0.584, p<0.01 vs r=0.518, p<0.01, respectively). This correlation was not found in patients with DM (Figure 1).Table 1.Demograpfic data and salivary gland ultrasonography scores in pSS and diabetic patientspSS patients(n=32)DM patients with sicca(n=28)Age, mean(±SD)53.90(±9,70)52.25(±7.65)Disease duration, mean(±SD)7.68(±4.01)8.46(±6.31)First symptom, n(%) Sicca5(15.62%)4(14.28%) Non-sicca23(71.87%)20(71.42%)Parotitis, n(%)7(21.87%)2(7.14%)aAnti-Ro positivity, n(%)22(68.75%)0(0.0%)aUnstimulated saliva flow rate ≤0.1 ml/m, n(%)28(87.5%)13(46.42%)aSchirmer’s test≤5 mm/5 m in at least one eye, n(%)30(93.75%)8(28.57%)aThe Hocevar total SGUS score, mean(±SD)20.93(±9.65)3.82(±3.71)a right parotid4.62(±2.73)1.25(±1.17)a left parotid4.34(±2.57)1.25(±1.08) a right submandibular6.06(±3.07)0.67(±0.41) a left submandibular6.31(±2.95)0.64(±0.43) aThe OMERACT total SGUS score,(mean(±SD)5.96(±2.30)2.07(±1.65) a right parotid1,28(±0.77)0,71(±0.59) a left parotid1,21(±0.65)0,78(±0.62) a right submandibular1,68(±0.82)0,44(±0.25) a left submandibular1,78(±0.83)0,47(±0.32) aap<0.05Figure 1.Correlation between SGUS scores and disease duratin in two groupsConclusionThis study demonstrated that the major salivary gland involvement was more severe, submandibular gland dominant and correlated with disease duration in pSS. Contrarily, in patients with DM, it was mild compared to pSS, parotid dominant and uncorrelated with disease duration.References[1]Mariette, X. and L.A. Criswell, Primary Sjögren’s syndrome. New England Journal of Medicine, 2018.[2]Gupta, A., et al., A Cross-Sectional Study on Ultrasonographic Measurements of Parotid Glands in Type 2 Diabetes Mellitus. Int J Dent, 2021.[3]Finzel, S., et al., Patient-based reliability of the Outcome Measures in Rheumatology (OMERACT) ultrasound scoring system for salivary gland assessment in patients with Sjögren’s syndrome. Rheumatology (Oxford), 2021.[4]Hocevar, A., et al., Ultrasonographic changes of major salivary glands in primary Sjogren’s syndrome. Diagnostic value of a novel scoring system. Rheumatology (Oxford), 2005.Disclosure of InterestsNone declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.