Ultrassonografia de articulações de pequeno, médio e grande porte de indivíduos saudáveis : uma comparação entre os gêneros

• Autor(a) principal: Tamashiro, José Carlos Nunes [UNIFESP]
• Data de Publicação: 2017
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5033860; http://repositorio.unifesp.br/handle/11600/50644
• topic: Diagnostic iImaging; Ultrasonography; Joints; Healthy volunteers; Diagnóstico por imagem; Ultrassonografia; Articulações; Indivíduos saudáveis; Voluntários saudáveis

Objectives: To compare between the genders through the musculoskeletal ultrasound (MSUS) of large, medium and small joints, in healthy volunteers, the following parameters: 1) Synovial hypertrophy (quantitative and semi-quantitative measurement in the gray scale); 2) Synovial blood flow (semi-quantitative measure of power Doppler - PD); And 3) subchondral bone erosion (semiquantitative measurement in the gray scale). Methods: A cross-sectional study was performed in which the MSUS of small, medium and large joints was compared between the genders of a population of healthy people. Inclusion criteria were as follows: both genders aged 18 to 80 years. Exclusion criteria were: pain or edema in any joint, presence of any other disease, pregnancy and breastfeeding. Group 1 was formed by 100 women and group 2, by 60 men. This assessment was performed in a single time for each individual. The groups were matched by age and body mass index (BMI). Individually, 46 joints recesses were evaluated. In total 7,360 joints recesses were studied for the quantitative measures (22,080 measurements). For the semi-quantitative, there were 22,720 measurements (synovial hypertrophy = 7,360, PD = 7,360 and bone erosion = 8,000). The joints and joints recesses chosen were those that are considered more relevant in the clinical practice of the rheumatologist. The study was bilateral in the following joints: 2nd and 3rd proximal interphalangeal (PIP), 2nd and 3rd metacarpophalangeal (MCP), wrist, elbow, glenohumeral, hip, knee, talocrural, talonavicular, talocalcaneal, 1st, 2nd and 5th metatarsophalangeal (MTP). Statistic: The following statistical tests were used: Kolmogorov-Smirnov, Mann- Whitney, Kruskall-Wallis, ANOVA, Pearson's Chi-square test, Student's t test and Fisher's exact test. A statistical significance of 5% (p <0.05) was considered. Results: The mean age of the sample was female / male: 45.0 (± 14.7) / 44.5 (± 14.6) p = 0.919. The BMI was female / male: 25.65 (± 4.43) / 26.11 (± 3.57) p = 0.472. Statistical difference was found in females for quantitative measurements of synovial hypertrophy in the following recesses: radiocarpal, radioulnar distal and ulnocarpal, 2nd and 3rd dorsal PIP, 2nd palmar MCP, 2nd and 3rd palmar PIP, glenohumeral (axillary and posterior), Hip, talocrural, talonavicular and talocalcaneal. In the male gender in the 5th dorsal MTP. For the semi-quantitative measurements, a statistical difference was found in the following recesses: A) synovial hypertrophy: in the 2nd and 3rd palmar MCP, 2nd palmar PIP, hip, talocrural, talonavicular, talocalcaneal and 2nd dorsal MTP, with greater measures in the female gender. B) power Doppler: talonavicular with major alterations in the female gender and, 1st, 2nd and 5th dorsal MTP, in the male gender. C) Bone erosion: radiocarpal, with major alterations in the female and talonavicular, with major alterations in the male gender. Conclusion: MSUS found greater quantitative and semiquantitative measures of synovial hypertrophy in the female gender. For the great majority of joints recesses, no statistical difference was found between the genders for PD measurement and bone erosion.