Trigger Finger Treatment / Tratamento do Dedo em Gatilho

Abstract Trigger finger is a frequent condition. Although tenosynovitis and the alteration of pulley A1 are identified as triggering factors, there is no consensus on the true cause in the literature, and its true etiology remains unknown. The diagnosis is purely clinical most of the time. It depends solely on the existence of finger locking during active bending movement. Trigger finger treatment usually begins with nonsurgical interventions that are instituted for at least 3 months. In patients with initial presentation with flexion deformity or inability to flex the finger, there may be earlier indication of surgical treatment due to pain intensity and functional disability. In the present review article, we will present the modalities and our algorithm for the treatment of trigger finger.

Resumo O dedo em gatilho é uma afecção frequente. Não obstante a tenossinovite e a alteração da polia A1 serem identificados como fatores desencadeantes, não há consenso sobre a verdadeira causa na literatura, sendo que a sua verdadeira etiologia permanece desconhecida. O diagnóstico é puramente clínico na maior parte das vezes. Ele depende unicamente da existência do travamento do dedo no decorrer da movimentação flexão ativa. O tratamento do dedo em gatilho geralmente se inicia com intervenções não cirúrgicas que são instituídas por pelo menos 3 meses. Nos pacientes em quem haja apresentação inicial com deformidade em flexão ou incapacidade de flexão do dedo, pode haver indicação mais precoce do tratamento cirúrgico em razão da intensidade do quadro álgico e da incapacidade funcional do paciente. No presente artigo de revisão, apresentaremos as modalidades e o nosso algoritmo para o tratamento do dedo em gatilho.

Tenosinovitis en artritis reumatoidea, evaluación por ultrasonido y resonancia magnética / Tenosynovitis in rheumatoid arthritis, ultrasound and magnetic resonance evaluation

La tenosinovitis es una manifestación frecuente de la artritis reumatoidea (AR), asociada a la presencia de rupturas tendinosas, discapacidad funcional y procesos erosivos de las articulaciones adyacentes. En los últimos años el manejo clínico de la AR ha sido respaldado por diferentes métodos de evaluación por imágenes, como la ultrasonografía (US) y la resonancia magnética (RM). Estas son herramientas de gran utilidad en la práctica clínica porque permiten la detección precoz de la actividad de la enfermedad y, por lo tanto, un tratamiento oportuno. Por medio de diferentes escalas de evaluación del daño articular y periarticular (como el tendinoso) es posible valorar el estado de la enfermedad y la respuesta al tratamiento. La presente revisión tiene como objetivo describir las escalas de evaluación de la RM y la US en la valoración de la tenosinovitis en pacientes con AR.

Tenosynovitis is a frequent manifestation of Rheumatoid Arthritis (RA), it is associated with tendon ruptures, functional disability, and erosive processes in the adjacent joints. In recent years, RA clinical management has been supported by different imaging methods such as ultrasound (US) and magnetic resonance (MR). These methods are particularly useful tools in clinical practice because they allow the early detection of disease activity and, therefore, prompt treatment. Through different evaluation scales of joint and periarticular damage (such as tendon) they also make possible to assess the state of the disease and the treatment response. The present review aims to describe the scores described for MRI and US to evaluate tenosynovitis in RA patients.

Ultrasound versus contrast-enhanced magnetic resonance imaging for subclinical synovitis and tenosynovitis: a diagnostic performance study

OBJECTIVES: Radiographic manifestations of synovitis (e.g., erosions) can be observed only in the late stage of rheumatoid arthritis. Ultrasound is a noninvasive, cheap, and widely available technique that enables the evaluation of inflammatory changes in the peripheral joint. In the same way, dynamic contrast-enhanced magnetic resonance imaging (MRI) enables qualitative and quantitative measurements. The objectives of the study were to compare the sensitivity and accuracy of ultrasound in detecting subclinical synovitis and tenosynovitis with those of contrast-enhanced MRI. METHODS: The ultrasonography and contrast-enhanced MRI findings of the wrist, metacarpophalangeal, and proximal interphalangeal joints (n=450) of 75 patients with a history of joint pain and morning stiffness between 6 weeks and 2 years were reviewed. The benefits score was evaluated for each modality. RESULTS: The ultrasonic findings showed inflammation in 346 (77%) joints, while contrast-enhanced MRI found signs of early rheumatoid arthritis in 372 (83%) joints. The sensitivities of ultrasound and contrast-enhanced MRI were 0.795 and 0.855, respectively, and the accuracies were 0.769 and 0.823, respectively. Contrast-enhanced MRI had a likelihood of 0-0.83 and ultrasound had a likelihood of 0-0.77 for detecting synovitis and tenosynovitis at one time. The two imaging modalities were equally competitive for detecting synovitis and tenosynovitis (p=0.055). CONCLUSION: Ultrasound could be as sensitive and specific as contrast-enhanced MRI for the diagnosis of subclinical synovitis and tenosynovitis.

Sevoflurano tópico como tratamiento analgésico y antimicrobiano de tenosinovitis piógena de los flexores de la mano. Caso clínico / Topical sevoflurane as analgesic and antimicrobial treatment of pyogenic flexor tenosynovitis of the hand. Case report

Presentamos el caso de un paciente con una tenosinovitis piógena del 5° dedo de la mano, tratado inicialmente con desbridamiento quirúrgico y antibioterapia empírica. La evolución fue desfavorable, pues el dedo presentaba un defecto de cobertura con signos infecciosos en la herida y las curas resultaban muy dolorosas. Al paciente se le ofertaron varias opciones quirúrgicas y, mientras se decidía por alguna, aceptó por escrito iniciar curas con sevoflurano líquido tópico (según protocolo vigente para uso de fármacos fuera de indicación). El efecto analgésico del sevoflurano apareció rápidamente, y la evolución posterior de la herida fue muy favorable, pues los signos infecciosos desaparecieron y el defecto de cobertura se había cerrado tras tres semanas de empleo de sevoflurano tópico, sin necesidad de nuevas cirugías. Este caso ejemplifica que el uso fuera de indicación de sevoflurano tópico para tratar heridas complejas puede evitar actuaciones quirúrgicas, mucho más agresivas para los pacientes.

The clinical case is presented on a patient suffering from pyogenic tenosynovitis affecting the 5th finger of the hand, which was initially treated with surgical debridement and empirical antibiotic treatment. The clinical outcome was unfavourable, since the finger presented with a coverage defect, and the wound seemed to be infected. Wound cleaning and dressings were very painful. The patient was asked to choose between several surgical therapeutic alternatives, but he gave written informed consent to be treated with topical sevoflurane, following an approved protocol for the off-label use of this drug. Pain was accurately controlled after sevoflurane application, and the wound exhibited a very good outcome with disappearance of the clinical signs of infection and complete closure of the defect coverage after three weeks of sevoflurane, with no new surgical procedures. The present clinical case illustrates how the off-label use of topical sevoflurane for the treatment of complicated wounds could be useful to avoid surgical procedures that are more aggressive for patients.

First Report of Tenosynovitis Caused by Mycobacterium virginiense in Korea

No abstract available.

Tenosinovitis estenosante de tendones flexores de la mano: revisión de la literatura / Stenosing flexor tenosynovitis of the hand: literature review

Flexor tendon tenosynovitis is an entrapment of the flexor tendons at its entrance to the pulley system. Because there is a high incidence of this pathology, it should be well known by physicians, rheumathologists and orthopaedic surgeons. On this paper we present a literature review, analyzing the anatomic facts, biomechanics, diagnosis, classification, therapeutic options and we propose some general recommendations for physicians.

Progress on treatment for stenosing tenosynovitis / 中国骨伤

Radial styloid stenosing tenosynovitis is a kind of common chronic motor system injuries, and could lead to joint pain and aggravates with activity, in further makes a great impact on people's daily life. At present, therapeutic methods for this disease could divid into conservative treatment and surgical treatment. What we pay attention to is cure. Conservative treatment could effectively relieve pain and improve wrist motion in acute phase, however, it make little difference on long--term effect and usually cause to reappear. Surgical treatment, as a kind of invasive therapies, is chosen only when facing recalcitrant radial styloid stenosing tenosynovitis with many complications for its high cure rate. The author thought that patient education should play an important role in the therapy of radial styloid stenosing tenosynovitis, comprehensive treatment could be applied according to the different conditions of disease development, and could increase cure disease.

Research progress of stenosing tenosynovitis of radial styloid process based on anatomical structure / 中国骨伤

Stenosing tenosynovitis of styloid process of radius(de Quervain's disease) which abductor pollicis longus and extensor pollicis brevis in the first extensor chamber are affected by resistance when sliding, the incidence is affected by anatomical variations. Symptoms, signs and auxiliary examinations can diagnose the disease. Slight dQS can be improved by rest, brace, restriction activities, and oral medications. Chinese medicine and physiotherapy also reduce the disease. Needle knife therapy is a Traditional Chinese medicine minimally invasive surgery, which is also a step-by-step treatment between conservative treatment and open surgery to loosening the compression of the first extensor chamber. Steroid injection is a more common treatment in this disease, and its efficacy is related to the accuracy of the injection and is affected by the severity of the patient's anatomical variation. Identifying the spacing within the first extensor chamber under ultrasound can help patients better choose conservative or surgical treatment. Surgical treatment can more completely change the condition of dQD from anatomical structure, and clinical should pay attention to the choice of surgical procedure to improve the efficacy and reduce the occurrence of surgical complications. This article discusses the pathogenesis, diagnosis and treatment of the disease from the perspective of anatomical structure. It mainly analyzes the therapeutic targets and the clinical application, which aims to provide reference for the diagnosis and treatment of de Quervain disease.

The Correlation Between Tenosynovitis Pattern on Two-Phase Bone Scintigraphy and Clinical Manifestation in Patients with Suspected Rheumatoid Arthritis / 대한핵의학회잡지

PURPOSE: To investigate the correlation between the tenosynovitis pattern on two-phase bone scintigraphy (2P-BS) and clinical manifestation in patients with suspected rheumatoid arthritis (RA).METHOD: 2P-BS including technetium-99m-methylene diphosphonate blood pool and bone phase imaging in 402 consecutive patients with clinically suspected RAwere retrospectively reviewed. According to 2010 RA Classification Criteria, patients were grouped as RA and non-RA. Visual assessment of all fingers, toes, wrists, and ankles on 2P-BS was performed. Clinical suspected tenosynovitis was evaluated on physical examination. Rheumatoid factor, anti-cyclic citrullinated protein antibody, C-reactive protein, and estimated sedimentation rate were obtained. Radiographic findings were also used to define early and established arthritis.RESULTS: Tenosynovitis pattern was detected in 12.7%(51/402 patients) on 2P-BS.A total of 94.1%(48/51) were diagnosed as RA vs. 5.9% (3/51) as non-RA. Of the 48 RA patients with positive 2P-BS finding, 85.4% (41/48) had early arthritis and 14.6% (7/48) had established arthritis. On physical examination, tenosynovitis was suspected in 21.9% (88/402). A total of 56.8% (50/88) belonged to the RA group and 43.2% (38/88) to the non-RA group. The tenosynovitis pattern of 2P-BS and physical examination showed statistical difference and moderate agreement. The positive tenosynovitis pattern on 2P-BS represented up to 26.408 of odds ratio which was highest among the RA-associated factors.CONCLUSION: Tenosynovitis pattern on 2P-BS was more commonly detected in the RA group and was more frequently associated with early arthritis pattern. Therefore, 2P-BS could give additional information for the detection of subclinical tenosynovitis in early or preclinical RA patients.

Tenosinovitis subclínica detectada por ecografía en pacientes con artritis reumatoidea en remisión clínica sostenida / Subclinical tenosynovitis detected by ultrasound in patients with rheumatoid arthritis under sustained clinical remission

El objetivo fue evaluar la prevalencia de tenosinovitis detectada por ecografía-doppler en pacientes con Artritis Reumatoidea (AR) en remisión clínica sostenida, determinar su asociación con las características de la enfermedad y determinar si la presencia de tenosinovitis ecográfica podría agregar información a la sinovitis para definir remisión ecográfica. Se incluyeron 60 pacientes con AR en remisión clínica (DAS28 <2,6, CDAI <2,8 y/o SDAI <3,3) sostenida a quienes se les realizó una ecografía con señal doppler de poder (DP). Un reumatólogo entrenado evaluó en forma bilateral: 1°-6° compartimentos extensores a nivel del carpo, 2°-5° tendones flexores de los dedos de las manos, tibial posterior, peroneo lateral corto y largo. A nivel articular se evaluaron en forma bilateral: carpo, 2°-5° metacarpofalángicas y 2°-5° interfalángicas proximales. Se definió remisión ecográfica a la ausencia de sinovitis en escala de grises (EG) grado ≥2 y la ausencia de señal DP a nivel articular o tendinoso. Se detectó tenosinovitis por EG grado ≥2 y señal DP ≥1 en 14 (23%; IC 95%: 12-34) y 13 (21,7%; IC 95%: 10-32) pacientes, respectivamente. Los tendones más frecuentemente afectados fueron: 6° compartimento extensor del carpo, tibial posterior y 3° tendón flexor tibial posterior. En el análisis multivariado, la única variable que se asoció con la presencia de tenosinovitis por ecografía-doppler fue la ERS (OR: 1,11; IC 95%: 1,02-1,22). Veintinueve pacientes (48,3%; IC 95%: 35-60) presentaron sinovitis subclínica y no fueron clasificados como AR en remisión ecográfica. La adición de la información brindada por la presencia de tenosinovitis subclínica, permitió clasificar 6 pacientes más sin remisión ecográfica, arrojando un total de 35 pacientes (58,3%; IC 95%: 45-70) (p=0,272).

The aims were to evaluate prevalence of ultrasound (US) tenosynovitis in Rheumatoid Arthritis (RA) patients in sustained clinical remission, its association with disease features and to assess whether the presence of tenosynovitis could add information to synovitis to define ultrasound (US) remission. Sixty consecutive RA patients in sustained (≥12 months) clinical remission (DAS28 <2.6, CDAI <2.8 and/or SDAI <3.3) were included. All patients underwent US examination by the same experienced rheumatologist. The following were bilaterally assessed: 1st-6th extensor tendon compartments at wrist level, 2nd-5th finger flexor tendons, posterior tibial, peroneal tendons, wrists, 2nd-5th metacarpophalangeal and 2nd-5th proximal interphalangeal. US remission was defined as the absence of synovitis on gray scale (GS ≥2) and the absence of power doppler (PD) signal at both joint and tendon level. Grey scale ≥2 and PD tenosynovitis were detected in 14 (23%; 95% CI: 12-34) and 13 (21.7%; 95% CI: 10-32) RA patients in clinical remission, respectively. The most frequent involved tendons were: 6th extensor wrist compartment, 3rd finger flexor and posterior tibials. In multivariate analysis, the only feature associated with the presence of subclinical tenosynovitis was erythrosedimentation rate (ESR)(OR: 1.11; 1.02-1.22). Twenty-nine (48.3%; 95% CI: 35-60) patients had subclinical synovitis and were not classified as in US remission. Adding the information of subclinical tenosynovitis, 6 more patients would have been classified as not in US remission, yielding a total of 35 patients (58.3%; 95% CI: 45-70) (p=0.272).

Tenosinovitis inespecífica en granos de arroz de los tendones flexores de la mano / Ténosynovite non spécifique d'aspect en grains de riz des tendons fléchisseurs de la main / Non-specific flexor tendons tenosynovitis in rice grains of the hand

La tenosinovitis con cuerpos libres en forma de granos de arroz es una afección muy infrecuente que se presenta, generalmente, asociada a artritis reumatoide o tuberculosis. Los casos no asociados a estas enfermedades son extremadamente raros. Se presenta un paciente masculino de 62 años de edad, intervenido quirúrgicamente por un síndrome del túnel carpiano derecho hace 7 años. En aquel momento se le realizó una apertura del retináculo transverso del carpo y una sinovectomía de los tendones flexores. La biopsia sinovial reportó una "sinovitis crónica". Evolucionó satisfactoriamente durante los primeros 4 años, luego comenzó a presentar nuevamente los síntomas compresivos del nervio mediano y un aumento progresivo del volumen en la cara anterior de la muñeca. El ultrasonido mostró una marcada hipertrofia sinovial de los tendones flexores a nivel de la muñeca. Los estudios neurofisiológicos reportaron daño axonal y mielínico en las fibras del nervio mediano derecho. Se le realizó una nueva intervención donde se visualizó la hipertrofia sinovial y abundantes cuerpos libres en forma de granos de arroz agrupados en sacos sinoviales. Se le descomprimió el túnel carpiano, se resecaron los cuerpos libres y se le hizo una sinovectomía amplia. El resultado de la biopsia fue una sinovitis inespecífica con cuerpos libres en granos de arroz. Después de dos años de operado el paciente está asintomático.

Tenosynovitis with loose rice grain-like structures is a very rare condition that usually presents associated with rheumatoid arthritis or tuberculosis. Cases not associated with these diseases are extremely rare. A 62-year-old male patient underwent surgery for a right carpal tunnel syndrome seven years ago. At that time, an opening of the transverse retinaculum of the carpus and synovectomy of the flexor tendons were performed. Synovial biopsy reported "chronic synovitis". It evolved satisfactorily during the first four years; then the patient began to present again the compressive symptoms of the median nerve and progressive increase in volume in the anterior aspect of the wrist. The ultrasound showed marked synovial hypertrophy of the flexor tendons at the level of the wrist. Neurophysiological studies reported axonal and myelin damage in the fibers of the right median nerve. A new intervention was performed. Synovial hypertrophy was visualized and abundant free loose rice grain-like structures grouped in synovial sacs. The carpal tunnel was decompressed, the free bodies were resected and wide synovectomy was performed. The result of the biopsy was non-specific synovitis with free rice grain-like structures. After two years of surgery, the patient is asymptomatic.

La ténosynovite à corps étrangers libres d'aspect en grains de riz est une affection très peu fréquente, étant généralement associée à l'arthrite rhumatoïde ou à la tuberculose. Les cas non associés à ces maladies sont extrêmement rares. Le cas d'un patient âgé de 62 ans, atteint de syndrome du canal carpien droit, et traité chirurgicalement il y a sept ans, est présenté. En ce moment-là, il a subi une incision du ligament transverse du carpe (rétinaculum) et une synovectomie des tendons fléchisseurs. La biopsie synoviale a dévoilé une «synovite chronique¼. L'évolution a été satisfaisante au cours des quatre premières années; puis après la compression du nerf médian et l'inflammation progressive de la face antérieure du poignet ont réapparues. L'échographie a montré une marquée hypertrophie synoviale des tendons fléchisseurs au niveau du poignet. Les examens neurophysiologiques ont révélé un dommage axonal et myélinique des fibres du nerf médian droit. Dans la nouvelle intervention effectuée, une hypertrophie synoviale et plusieurs corps étrangers d'aspect en grains de riz groupés en bourses synoviales ont été remarqués. Une décompression du canal carpien, une résection des corps étrangers et une large synovectomie ont été réalisées. La biopsie a repéré une synovite non spécifique à corps étrangers libres en forme de grains de riz. Le patient reste encore asymptomatique depuis deux ans.

Estudo anatômico das variações da inserção do músculo abdutor longo do polegar / Anatomical study of the variations of the insertion of the abductor muscle long the thumb

RESUMO Este é um estudo da variação anatômica da inserção do tendão do músculo abdutor longo do polegar. O objetivo deste estudo foi realizar uma descrição das variações antômicas do tendão do músculo Abdutor Longo do Polegar (ALP), por meio de uma dissecção anatômica de 20 cadáveres, todos afrodescendentes, no laboratório de anatomia humana da faculdade de medicina de Santos UNIMES. Palavras-chave: Tendões, Marcação in situ das Extremidades Cortadas, Tenossinovite de De Quervain, Rizartrose

Sural Nerve Entrapment and Tenosynovitis of Peroneus Longus by Hypertrophied Peroneal Tubercle: A Case Report / 대한족부족관절학회지

A hypertrophied peroneal tubercle can present as a bony prominence at the lateral aspect of the foot and a peroneal tenosynovitis or tear. We report a case of a 52-year-old man complaining of lateral foot tingling pain and numbness. The sural nerve entrapment and peroneus longus tenosynovitis by hypertrophied peroneal tubercle were confirmed. Good results were obtained after excision of the hypertrophied peroneal tubercle and sural nerve release.

Review of MRI wrist results at KAUH

Background: Magnetic resonance imaging [MRI] is defined as one of the most important modalities used for diagnosing lesions of small and complex structures in the body [1]. We aimed to investigate the most common wrist pathologies detected by MRI in KAUH [King Abdulaziz University Hospital] in Jeddah

Methodology: A retrospective study was done with a total sample size of 127 individuals who underwent wrist MRI investigation at KAUH in Jeddah [Saudi Arabia], between 2010-2016. The data entry was performed by using Microsoft Excel 2014, and statistical analysis was performed by SPSS V21

Results: The results of the analysis showed that the most common wrist pathology was ganglion cysts, constituting 17.8% of the 157 findings we observed. Other common findings were Tenosynovitis [10.2%], TFCC [Triangular fibrocartilage complex] tear [10.2%], TFCC degeneration [5.7%] and subchondral cysts [3.8%]. There was also a significant relation between normal/abnormal findings in individuals and their age of presentation. Age mean was 29.27 [ +/- 7.46 SD] for those with normal findings, and 37.33 [ +/- 15.62 SD] for those with abnormal findings, [P value less than 0.001]. Regarding X-ray investigation, we found that most of the sample [65.4%] did not undergo X-ray prior to MRI

Conclusion: It has been found that there is variance between all findings that were discovered by MRI, that there are differences between our study and those of others, and that due to the different sorts of cases that were presented to the hospital. We also found that most of the individuals with wrist pathologies did not get X-rays before MRI, so we recommend a clear policy of ordering MRI, also proper history and examination should be the essential tool to reach hand and wrist diagnoses. That will help in saving resources

Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome: A Case Report

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare condition that occurs in elderly individuals. It is characterized by sudden onset of bilateral symmetrical distal tenosynovitis that accompanied by obvious swelling of the hand with pitting edema and absence of rheumatoid factor (RF). This disease entity sometimes presented as overlap syndrome with other rheumatic diseases and needed to be differentiated from those. However, if the diagnosis is confirmed, the response to steroid is good. The purpose of this report is to describe the case of RS3PE syndrome presented with bilateral hand dorsum edema in a middle-aged woman.

Tendon Problems of the Ulnar Wrist / 대한정형외과학회잡지

It is challenging for orthopedic surgeons to diagnose pain at the ulnar aspect of the wrist due to the small and complex anatomical structures involved. Ulnar-sided wrist pain can also result from tendon problems, including extensor carpi ulnaris tendon and flexor carpi ulnaris tendon. Disorders of the extensor carpi ulnaris tendon include subluxation, dislocation, stenosing tenosynovitis, and tendinopathy. Unlike the extensor carpi ulnaris tendon which is prone to subluxation, dislocation and stenosing tenosynovitis from passing through as sheath, a flexor carpi ulnaris tendon is unsheathed, and calcific tendinitis and crystal deposition disease can occur at the distal tendinous portion of the flexor carpi ulnaris tendon.

Successful Treatment of Protothecal Tenosynovitis in an Immunocompetent Patient using Amphotericin B Deoxycholate

Protothecosis is an uncommon human infection caused by achlorophyllic algae of the genus Prototheca, especially P. wickerhamii. The skin is the most frequently involved organ and cases of protothecal tenosynovitis are very rare. A 71-year-old woman without prior medical history except hypertension presented with painful swelling of her right hand that did not improve despite receiving antibiotic treatment. She underwent tenosynovectomy and drainage. Histopathologic examination revealed necrotizing granulomatous inflammation and numerous spherical or morula-like organisms with a spoked wheel appearance. P. wickerhamii was identified from tissue culture. The lesion did not improve with empirical fluconazole therapy. Conventional amphotericin B was administered according to antifungal susceptibility tests and the lesion completely resolved. Protothecosis should be considered in the differential diagnosis for chronic tenosynovitis that does not respond to conventional antibacterial treatment; tissue biopsy with culture is required for diagnosis.

A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients / Novo sistema de escore ultrassonográfico (US10) musculoesquelético das articulações das mãos e punho para avaliação de pacientes com artrite reumatoide em fase inicial

ABSTRACT Objective: To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables. Methods: Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0–1) and semi-quantitatively (grades 0–3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP). Results: Mean duration of symptoms was 7.58 ± 3.59 months. Significant correlations (p < 0.05) were found between inflammation parameters and CRP at baseline and between the changes in these variables throughout the study. Significant correlations (p < 0.05) were found between DAS28 score and both PD and TN at baseline and between the changes in DAS28 score and both SP and TN throughout the follow up. Moreover, significant correlations were found between the changes in inflammation parameter scores and HAQ score throughout the follow up. Conclusion: The proposed US10 scoring system proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status.

RESUMO Objetivo: Propor um novo sistema de escore ultrassonográfico das articulações da mão e punho (US10) para a avaliação de pacientes com artrite reumatoide (AR) e correlacionar o US10 com variáveis clínicas, laboratoriais e funcionais. Métodos: Foram submetidos 48 pacientes com AR em fase inicial a avaliações clínicas e laboratoriais, bem como a exames cegos de ultrassom (US) no início do estudo e com 3, 6 e 12 meses. O sistema US10 proposto envolveu a avaliação do punho e das articulações metacarpofalângicas e interfalângicas proximais do segundo e terceiro dígitos. O escore consistiu em parâmetros inflamatórios (proliferação sinovial [PS], Power Doppler [PD] e tenossinovite [TN]) e parâmetros de danos articulares (erosão óssea [EO] e danos na cartilagem [DC]). PS, PD, EO e DC foram pontuados qualitativamente (0 a 1) e semiquantitativamente (graus 0 a 3). A tenossinovite foi pontuada como presença/ausência. A avaliação envolveu também o escore 28-Joint Disease Activity (DAS28), o Health Assessment Questionnaire (HAQ) e o nível de proteína C-reativa (PCR). Resultados: A duração média dos sintomas foi de 7,58 ± 3,59 meses. Foram encontradas correlações estatisticamente significativas (p < 0,05) entre os parâmetros de inflamação e a PCR no início do estudo e entre as mudanças nessas variáveis ao longo do estudo. Foram encontradas também correlações significativas (p < 0,05) entre o escore DAS28 e a PD e TN no início do estudo e entre as mudanças no escore DAS28 e PS e TN em todo o seguimento. Além disso, foram encontradas correlações significativas entre as mudanças no escore dos parâmetros de inflamação e no escore HAQ ao longo do seguimento. Conclusão: O sistema de escore US10 proposto provou ser uma ferramenta útil para monitorar a inflamação e o dano articular em pacientes com AR em fase inicial, demonstra correlações significativas com as alterações longitudinais na atividade da doença e no estado funcional.