Ankilozan spondilitli hastalarda tanısal ultrasonografi ile entezit bölgelerinin değerlendirilmesi
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Dosyalar
Tarih
2015
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Entezit ligament, tendon, annulus fibrozus ve eklem kapsülünün kemiğe insersiyosunun inflamasyonudur. Bu tablo spondiloartrit grubu hastalıkların karakteristiğidir. Ankilozan spondilitte entezit sıklığı %25-40 arasındadır. Ancak gerçek prevelans entezit değerlendirme yöntemine (klinik muayene, görüntüleme, histolojik tanı) göre değişebilir. Bizim de çalışmamızdaki amacımız, ankilozan spondilitli hastalarda entezit sıklığını fizik muayene indeksleri ve ultrason skorlama sistemleri ile belirleyip aralarındaki ilişkiyi araştırmak ayrıca hasta grubun ultrason entezit skorlarını sağlıklı grupla karşılaştırıp farkları araştırmaktı. Ankilozan spondilit nedeniyle takip edilen hastalar ve kas-iskelet hastalığı olmayan sağlıklı kişiler çalışmaya alındı. Hastaların yaşı, boyu, kilosu, cinsiyeti, mesleği, hastalık semptom süresi, sedimentasyon ve C-reaktif protein değeri incelendi. Bunların hastaların ultrason entezit skorları ile ilişkisi araştırıldı. Hastalık aktivitesi Bath Akilozan Spondilit Hastalık Aktivite İndeksi ile belirlendi. Entezit değerlendirme yöntemleri olarak Maastricht Ankilozan Spondilit Entezit Skoru ve Glasgow Ultrason Entezit Skorlama Sistemi kullanıldı. Hastaların Bath Akilozan Spondilit Hastalık Aktivite İndeksi ve Maastricht Ankilozan Spondilit Entezit Skoru ilişkiliydi. Ancak her iki değerlendirme Glasgow Ultrason Entezit Skorlama Sistemi sonuçları ile ilişkisiz bulundu. Ultrason entezit skoru sonuçları hastaların sedimentasyon ve C-reaktif protein değerleri ve hastalık semptom süresi ile de ilişkisizdi. Ultrason skor sonuçları ankilozan spondilitli erkeklerde daha yüksek bulundu. Ankilozan spondilitli hastalarda sağlıklı kişilere göre anlamlı yüksek oranda ultrasonda entezit bulgusu saptandı. Sağlıklı kişilerde beden gücü ile aktif çalışanlarda entezit oranı aktif çalışmayanlara göre anlamlı yüksek bulundu. Ultrasonun fizik muayene entezit indekslerine göre daha hassas olduğu ve hastalık aktivite indekslerinden bağımsız enteziti daha iyi saptamamızı sağladığı tespit edildi. Entezit değerlendirmede ultrasonun duyarlı bir görüntüleme yöntemi olduğu ve klinik muayenenin tamamlayıcısı olarak kullanılabileceği düşünüldü.
abstract
Enthesitis can be defined inflammation at the insertion of tendons, ligaments and capsules into the bone, which is seen as a primary lesion that may underlie all spondyloarthritis. The frequency of enthesitis in ankylosing spondylitis is between %25-40. However, the real prevalence can change according to the enthesitis evolution method (clinical examination, screening, histological diagnosis). Our aim in this study was to specify the frequency of enthesitis among the patients with ankylosing spondylitis, by physical examination indexes and ultrasound score systems. Then we investigated the relation between methods. Also we aimed to compare ultrasound scoring results of the patient group with those of healthy group. Ankylosing spondylitis and healthy controls who does not have any musculoskeletal system complaint were included into the study. Age, height, weight, gender, occupation, durations of the symptom, sedimentation and C-reactive protein rates of each patient were noted. The relation of all these parameters with the patients' ultrasound enthesitis scores were checked. Disease activity was determined by Bath Ankylosing Spondilitis Disease Activity Index. Maastricht Ankylosing Spondilitis Enthesitis Score and Glasgow Ultrasound Enthesitis Score System were used as clinic and ultrasonographic enthesitis evaluations respectively. Bath Anklosing Spondilitis Disease Activity Indexes of the patients and Maastricht Anklosing Spondilitis Enthesitis Scores were correlated. However no correlation was found between both of those rates and finding of Glasgow Enthesitis Score System. The ultrasound enthesitis score did not have significant correlation with the sedimentation and C-reactive protein rates and the symptom durations of the patients. Ultrasound score results were higher for males in pateints with ankylosing spondylitis. The number of the enthesitis diagnosed by ultrasound was considerably high in patients with anklosing spondilitis compared to the healthy people. The rates of enthesitis was considerably high in healthy active employees working with physical strength when compared with healthy non-workers. It has been determined that ultrasound is much more sensitive than the physical examination indexes and it also ultrasound has an advantage to diagnose enthesitis independently from disease avtivity indexes. Also enthesitis evaluation ultrasound is thought to be a precise screening method and it can be used as supplementary to the clinical examination.
abstract
Enthesitis can be defined inflammation at the insertion of tendons, ligaments and capsules into the bone, which is seen as a primary lesion that may underlie all spondyloarthritis. The frequency of enthesitis in ankylosing spondylitis is between %25-40. However, the real prevalence can change according to the enthesitis evolution method (clinical examination, screening, histological diagnosis). Our aim in this study was to specify the frequency of enthesitis among the patients with ankylosing spondylitis, by physical examination indexes and ultrasound score systems. Then we investigated the relation between methods. Also we aimed to compare ultrasound scoring results of the patient group with those of healthy group. Ankylosing spondylitis and healthy controls who does not have any musculoskeletal system complaint were included into the study. Age, height, weight, gender, occupation, durations of the symptom, sedimentation and C-reactive protein rates of each patient were noted. The relation of all these parameters with the patients' ultrasound enthesitis scores were checked. Disease activity was determined by Bath Ankylosing Spondilitis Disease Activity Index. Maastricht Ankylosing Spondilitis Enthesitis Score and Glasgow Ultrasound Enthesitis Score System were used as clinic and ultrasonographic enthesitis evaluations respectively. Bath Anklosing Spondilitis Disease Activity Indexes of the patients and Maastricht Anklosing Spondilitis Enthesitis Scores were correlated. However no correlation was found between both of those rates and finding of Glasgow Enthesitis Score System. The ultrasound enthesitis score did not have significant correlation with the sedimentation and C-reactive protein rates and the symptom durations of the patients. Ultrasound score results were higher for males in pateints with ankylosing spondylitis. The number of the enthesitis diagnosed by ultrasound was considerably high in patients with anklosing spondilitis compared to the healthy people. The rates of enthesitis was considerably high in healthy active employees working with physical strength when compared with healthy non-workers. It has been determined that ultrasound is much more sensitive than the physical examination indexes and it also ultrasound has an advantage to diagnose enthesitis independently from disease avtivity indexes. Also enthesitis evaluation ultrasound is thought to be a precise screening method and it can be used as supplementary to the clinical examination.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Ankilozan Spondilit, Ultrason, Entezit, Ankylosing Spondilitis, Ultrasound, Enthesitis
