Musculoskeletal ultrasonography of the elbow joint in dogs: applicability and evaluation protocol / Ultrassonografia musculoesquelética da articulação do cotovelo em cães: aplicabilidade e protocolo de avaliação

The elbow is a complex joint and has great clinical relevance in small animal medicine. Previous research in this area has been performed using radiographic and tomographic methods; however, there are limited studies on ultrasonography. The aims of this study was suggesting an evaluation protocol for elbow scan and describe the ultrasonographic anatomy of the elbow joint in dogs. Ten cross-breed dogs weighing 5-15kg underwent radiography and were selected for this ultrasonographic study. The protocol was established for the ultrasonographic description dividing the articular areas in the proximal, middle, and distal, lateral, cranial, medial, and caudal faces. The approach was performed in the longitudinal, transverse and oblique planes and the musculoskeletal structures were described according to the architecture, echogenicity and echotexture. Computed tomography and magnetic resonance imaging scans were obtained for one animal for comparison. Ultrasonography was effective in visualizing and analyzing muscles, tendons and ligaments. Bone contours and regions that have clinical significance such as the medial coronoid process and anconeus process were identified, but with limited access. Prior knowledge of the normal sonographic anatomy of the elbow joint, as well as its technical advantages and limitations will allow further studies related to the identification of musculoskeletal disorders.(AU)

O cotovelo é uma articulação complexa e tem grande relevância clínica na medicina veterinária de pequenos animais. Pesquisas prévias nesta área foram realizadas utilizando radiografias e tomografia computadorizada, entretanto há limitados estudos com ultrassonografia. O objetivo desse estudo é sugerir um protocolo de avaliação da articulação do cotovelo e descrever sua anatomia ultrassonográfica. Dez cães sem raça definida, pesando 5-15kg foram submetidos à radiografias e foram selecionados para o estudo ultrassonográfico. O protocolo foi estabelecido para a descrição anatômica ultrassonográfica dividindo as articulações em proximal, média e distal, faces lateral, cranial, medial e caudal. A abordagem foi realizada nos planos longitudinal, transverso e oblíquo e as estruturas foram descritas de acordo com a arquitetura, ecogenicidade e ecotextura. Tomografia computadorizada e ressonância magnética foram realizadas em um animal para comparação. A ultrassonografia foi efetiva na visualização e análise de músculos, tendões e ligamentos. Os contornos ósseos e regiões com significado clínico como o processo coronóide medial e o processo ancôneo foram identificados, mas com acesso limitado. Conhecimento prévio da anatomia ultrassonográfica normal da arquitetura do cotovelo, bem como suas vantagens e limitações, irão permitir estudos adicionais relacionados à identificação de desordens musculoesqueléticas.(AU)

Simplified Radiographic Damage Index for Affected Joints in Chronic Gouty Arthritis

The aim of this study was to develop and validate a new radiographic damage scoring method (DAmagE index of GoUt; DAEGU) in chronic gout using plain radiography. Two independent observers scored foot x-rays from 15 patients with chronic gout according to the DAEGU method and the modified Sharp/van der Heijde (SvdH) method. The 10 metatarsophalangeal (MTP) and 2 interphalangeal (IP) joints of the first toes of both feet were scored to assess the degrees of erosion and joint space narrowing (JSN). The intraobserver and interobserver reliabilities were analyzed by calculating the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). The correlation between the DAEGU and SvdH methods was analyzed by calculating the Spearman's rho correlation coefficients and Kappa coefficients. The DAEGU method was found to be highly reproducible (0.945-0.987 for the intraobserver and 0.993-0.996 for the interobserver ICC values). The erosion, JSN, and total scores exhibited strong positive correlations between the DAEGU and SvdH methods and also within each method (r = 0.860-0.969, P < 0.001 for all parameters). The DAEGU and SvdH methods were in very good agreement as determined by Kappa coefficient analysis [0.732 (0.387-1.000) for erosion and 1.000 (1.000-1.000) for JSN]. In conclusion, this study revealed that DAEGU method was a reliable and feasible tool in the assessment of radiographic damage in chronic gout. The DAEGU method may provide a more easy assessment of structural damage in chronic gout in the real clinical practice.

Estudo radiográfico da articulação lombossacra em cães das raças Pastor Alemão, Rottweiler e Doberman / Radiographic study of the lumbosacral joint in German Shepherd, Rottweiler and Doberman dogs

Este trabalho teve como objetivo avaliar a variação entre diferentes raças das medidas radiográficas da articulação lombossacra. Foram utilizados 20 cães da raça Pastor Alemão, 20 cães da raça Rottweiler e 20 da raça Doberman. A articulação lombossacra foi avaliada radiograficamente com os membros pélvicos em posição neutra (N), em ventroflexão (VF) e dorsoextensão (DE). Foram mensurados os ângulos entre os processos articulares de L7 e S1 (PA), entre as epífises distal de L7 e proximal de S1 (EPIF), o ângulo lombossacro (LS), a amplitude de movimento (ROM) desses ângulos, o ponto de interseção das retas que formam esses ângulos e a respectiva ROM. Os resultados mostraram que a altura do canal vertebral em L7 é menor no Pastor Alemão (9,5mm) e maior no Rottweiler (10,5mm). O EPIF-DE foi maior no Pastor Alemão (38,03º). O PA-N foi menor no Pastor Alemão (15,98º). O LS-VF foi menor no Doberman (170,01º), e não diferiu entre o Pastor Alemão (179,17º) e o Rottweiler (176,61º). Os cães Pastores Alemães demonstraram uma maior ROM dos ângulos EPIF e LS. Concluiu-se que cães da raça Pastor Alemão apresentam maior instabilidade dessa articulação em relação às outras duas raças estudadas.(AU)

The purpose of this work was to evaluate the racial difference of radiographic measurements of canine lumbosacral joints.20 German Shepherd, 20 Rottweiler and 20 Doberman dogs were used in the study. The lumbosacral joint was assessed radiographically with the hind limbs in neutral position (N), in ventral flexion (VF) and dorsal extension (DE). We measured the angles between the L7 and S1 articular processes (PA), between the distal L7 and S1 proximal epiphysis (EPIF), the lumbosacral angle (LS), range of motion (ROM) of these angles, the intersection point of the lines that form these angles and their ROM. The results show that the height of the spinal canal in L7 is lower in German Shepherds (9.5mm) than in Dobermans (10mm) and Rottweilers (10.5 mm). The EPIF-DE was higher in the German Shepherd (38.03°). The PA-N was lower in German Shepherd (15.98 °). The LS-VF was lower in the Doberman (170.01°), and LS did not differ statistically between German Shepherd (179.17°) and Rottweiler (176.61°). The ROM of the LS and EPIF angles were greater in the German Shepherd dogs. It was concluded that the German Shepherd dogs have radiographic measurements that lead to greater instability of the lumbosacral joint.(AU)

Ultrasonographic studies on the fetlock suspensory apparatus in draught horses

Suspensory injuries of the fetlock were studied ultrasonographically in 25 mixed breed draught horses. Sesamoiditis, fractures of the proximal sesamoid bones and proximal phalanx were the common radiography findings in the hard tissues. Ultrasonographic of soft tissues of the suspensory apparatus in the present study here showed multiple complicated structural injuries. The suspensory branches showed desmitis, increased in size, dystrophic calcification, tearing, and fibrous echo dense material between the branch and the skin. Desmitis of the distal sesamoidean ligament had been seen associated with fractures of proximal phalanx and fractures of the sesamoid bones. Osteoarthritis of the fetlock joints was concomitant studied in the horses. Chronic desmitis of both the straight and oblique distal sesamoidean ligaments were encountered with hypoechoic core lesions in addition with irregularity of the bone surface echoes of the PI. Moreover, there were concurrent injuries to digital flexor tendons and the suspensory ligament as well as the distal sesamoidean ligaments in draught horses. The present study showed that ultrasonographic examination was useful for assessing the profile of the suspensory apparatus abnormalities in draught horses. The characteristic abnormalities of suspensory apparatus reported in the present study showed multiple complicated disorders that would affect the prognosis of fetlock injuries

Rheumatoid arthritis: early induction of disease remission

To evaluate the efficacy of tumor necrosis factor-alpha [TNF-alpha] blockade as bridge-therapy combined with methotrexate [MTX] in induction of early remission in rheumatoid arthritis patients. Patients and Sixty six patients with rheumatoid arthritis with poor prognostic disease features were enrolled in the current study. All had moderate to severe disease activity with unsatisfactory response to disease modifying antirheumatic drugs [DMARDs] mono-therapy. Patients were randomized into 3 groups: Group 1 were the patients who received TNF-alpha blockade therapy in combination with methotrexate [MTX] for 6 weeks than they were maintained on MTX alone for 18 weeks, group 2 included patients who received MTX mono-therapy and patients in group 3 who received prednisolone according to micro-dose regimen with MTX. All patients underwent initial full clinical examination as well as laboratory investigations [baseline evaluation]. The following disease activity parameters were determined at baseline, 6 weeks and 24 weeks after being enrolled in the study: Global patieny's and global physician's assessment scores, patients's pain score, number of tender as well as swollen joints, Health assessment questionnaire, serum C-reactive protein, erythrocyte sedimentation rate as well as morning stiffness duration. Standard plain X-rays were carried out for both hands, wrists, ankles as well as the forefeet. Joint erosions were assessed according to Larsen's score. Induction of disease remission after the 1st 6 weeks of therapy occurred in 45.45%, 27.27%, 36.36% in group1, 2 and 3 respectively, reflecting the higher efficacy of TNF-alpha blockade therapy in induction of early disease remission. After 18 weeks of stopping TNF-alpha blockad and maintaining the patients of group1 on MTX [24 weeks from start of the study], the 3 study groups showed comparable disease control revealing the absence of superiority of TNF-alpha blockade therapy compared with prednisolone-MTX combination as well as MTX monotherapy. On the other hand radiological evaluation of joint damage showed comparable incidence of joint erosions in the 3 groups reflecting equal efficacy of the 3 treatment regimens in controlling joint destruction. In view of results of the current study it can be concluded that TNF-alpha blockade is an effective therapy in RA that can induce early disease remission, however, this induced remission was not associated with superior efficacy in protection of joint damage compared with MTX mono-therapy and combined MTX-steroid therapy