ABSTRACT
OBJECTIVE: To compare the frequency of joint and tendon disease on ultrasound (US) and clinical examination, and to investigate agreement between US and clinical evaluation in ankles with clinically active juvenile idiopathic arthritis (JIA). METHODS: US and clinical evaluation were performed independently in the joint and tendon compartments of 105 ankles. Gray-scale (GS) US and power Doppler (PD) US joint abnormalities were scored on a 4-point semiquantitative scale. A joint with a GS score ≥2 and/or a PD score ≥1 was defined as active on US. Agreement was tested using kappa statistics. RESULTS: A total of 163 joints in 89 ankles had active synovitis on US. The tibiotalar (TT) joint was the most commonly affected joint on US and on clinical evaluation. The intertarsal (IT) joint and the subtalar (ST) joint were the second in frequency on US and on clinical evaluation, respectively. Tenosynovitis was found more commonly on US than on clinical evaluation (70.5% and 32.4%, respectively), and was more frequent in the medial and lateral than in the anterior tendon compartment. Isolated tenosynovitis was detected on US in 12 of 105 ankles. Agreement between US and clinical evaluation for detection of active synovitis and tenosynovitis was less than acceptable (κ <0.4). No correlation was found between any feature of active disease recorded on clinical evaluation (joint swelling, tenderness/pain on motion, and restricted motion) and active synovitis on US in the TT joint, ST joint, and IT joint. CONCLUSION: Coupling clinical evaluation with US aids in correctly localizing pathology. US training of practitioners is recommended to manage ankle disease in JIA.
Subject(s)
Ankle Joint/diagnostic imaging , Arthritis, Juvenile/diagnostic imaging , Physical Examination , Synovitis/diagnostic imaging , Tenosynovitis/diagnostic imaging , Ultrasonography, Doppler , Age Factors , Ankle Joint/physiopathology , Arthritis, Juvenile/physiopathology , Biomechanical Phenomena , Child , Child, Preschool , Female , Humans , Male , Predictive Value of Tests , Range of Motion, Articular , Synovitis/physiopathology , Tenosynovitis/physiopathologyABSTRACT
Os objetivos deste artigo foram abordar aspectos grais da osteoporose e revisar a literatura acerca do tratamento desta afecção; apresentar dados atuais sobre os efeitos biológicos do paratormônio (PTH) no metabolismo ósseo e discutir o papel do teriparatide (rPTH 1-34, forma recombinante do PTH humano) no moderno tratamento da osteoporose. O método utilizado foi à revisão, através de biblioteca virtual, dos dados atuais acerca dos efeitos osteometabólicos do PTH e revisão, a partir do Méd-line, dos artigos disponíveis envolvendo o uso clínico do rPTH em pacientes com osteoporose . O rPTH, quando usado de forma intermitente, induz formação óssea em modelos animais e em pacientes com osteoporose. Carcinogênese em murinos tratados com doses altas de PTH foi eventualmente descrita. O número de estudos clínicos controlados envolvendo o fármaco é ainda pequeno. O rPTH diminui o índice de fraturas, particularmente em ossos trabeculados. O uso combinado de bifosfonatos parece diminuir o efeito anabólico do rPTH. O rPTH, ao estimular a atividade osteoblástica, funciona como agente anabólico em pacientes com osteoporose. O alto custo e a reconhecida eficácia das drogas anti-reabsortivas limitam a indicação clínica do RPTH nestes pacientes. Entretanto, em situações específicas o fármaco pode se constituir em estratégias útil.
