Romatoid artrit hastalarında ultrasonografik median sinir kesit alanının elektrofizyolojik ölçümler ve hastalık aktivitesi ile ilişkisinin araştırılması
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Tarih
2022
Yazarlar
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada Romatoid Artrit hastalarında ultrasonografik median sinir kesit alanının elektrofizyolojik ölçümler ve hastalık aktivitesi ile ilişkisinin araştırılması amaçlandı.
Yöntem: Klinik ve elektrofizyolojik incelemelerle Karpal Tünel Sendromu (KTS) tanısı konan 30 romatoid artrit (RA) hastası, KTS olmayan 30 RA hastası ve 30 idiyopatik KTS kontrol grubu çalışmaya alındı. Hastaların yaş, cinsiyet, VKİ, hastalık süresi, kullandıkları ilaçlar, RF, anti CCP, ESH ve CRP değerleri kaydedildi. RA’lı hastalarda hastalık aktivitesi, DAS-28 ile değerlendirildi. Hastaların KTS semptom şiddeti ve fonksiyonel değerlendirilmesi için Boston KTS anketi, sağlıkla ilişkili yaşam kalitelerini ölçmek için Sağlık Değerlendirme Anketi (HAQ) kullanıldı. Ultrasonografik olarak tüm katılımcıların proksimal karpal tünel seviyesinde median sinir kesit alanı (MSKA) ölçümü yapıldı. Hastalar USG ile değerlendirildikten en geç 1 hafta sonra nörofizyolojik olarak değerlendirildi.
Bulgular: KTS+ RA olan grubun yaş ortalaması diğer iki gruba göre anlamlı derecede yüksek saptandı (p=0,023), diğer sosyodemografik veriler açısından gruplar arasında fark yoktu.
RA tanılı KTS+ ve KTS- grupların cinsiyet, kullandıkları RA ilaçları, RF ve anti-CCP pozitifliği ve DAS-28 skorları benzer iken, KTS+ RA’lı hastaların median sinir kesit alanı (12,95±2,35 vs 9,45±2,47 mm2, p<0,001) ve HAQ skorları (1,22±0,58 vs 0,80±0,62, p=0,006) istatistiksel olarak anlamlı düzeyde yüksek bulundu.
KTS olan gruplar birbiriyle ile karşılaştırıldığında, VKİ, KTS süresi, Boston semptom şiddet skoru, Boston fonksiyonel durum skoru ve HAQ skorları yönünden gruplar arasında fark yoktu. İdiyopatik KTS’li hastaların median sinir kesit alanı (15,13±3,32 mm2), KTS+RA’lı hastalardan (13,26±2,44 mm2) istatistiksel olarak anlamlı derecede yüksek saptandı (p=0,048). Duyusal elektrofizyolojik ölçümler açısından KTS grupları arasında fark yok iken KTS+ RA’lı hastaların median sinir motor iletim hızı (52,64±6,55 vs 58,97±6,64 m/sn, p<0,001) ve median sinir motor amplitüdü (4,51±1,05 vs 4,96±0,18 mV, p=0,021) idiyopatik KTS grubuna göre anlamlı derecede düşük idi.
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Sonuç: Çalışmamızın sonuçları, median sinir kesit alanının RA’lı hastalardaki KTS'de zayıf tanı potansiyeline sahip olduğunu ve hastalık aktivitesi ile korele olmadığını göstermektedir. Bu hastalarda USG’nin patofizyolojiyi aydınlatmak ve bölgenin anatomik yapısını değerlendirmek amacıyla kullanılması daha uygun görünmektedir.
In this study, we aimed to investigate the relationship of median nerve cross-sectional area with electrophysiological measurements and disease activity in rheumatoid arthritis patients. Material and Methods: Thirty rheumatoid arthritis (RA) patients diagnosed with carpal tunnel syndrome (CTS) by clinical and electrophysiological examinations, 30 RA patients without CTS and 30 idiopathic CTS control groups were included in the study. Age, gender, BMI, disease duration, medications, RF, anti CCP, ESR and CRP values of the patients were recorded. Disease activity in patients with RA was evaluated with DAS-28. The Boston CTS questionnaire was used for the symptom severity and functional evaluation of the patients. Health Assessment Questionnaire (HAQ) was used to measure the health-related quality of life. Ultrasonographic median nerve cross-sectional area (MSCA) was measured at the level of the proximal carpal tunnel of all participants. The patients were evaluated neurophysiologically no later than one week after they were evaluated with USG Results: The mean age of the group with CTS+ RA was found to be significantly higher than the other two groups (p=0.023). There was no difference between the groups in terms of other sociodemographic data. While the sex, RA drugs used, RF and anti-CCP positivity and DAS-28 scores of the CTS+ and CTS- groups with a diagnosis of RA were similar, the median nerve cross-sectional area (12.95±2.35 vs 9.45±2 .47 mm2, p<0.001) and HAQ scores (1.22±0.58 vs 0.80±0.62, p=0.006) of the patients with CTS+ RA were found to be statistically significantly higher. When the groups with CTS were compared with each other, there was no difference between the groups in terms of BMI, duration of CTS, Boston symptom severity score, Boston functional status score and HAQ scores. Median nerve cross-sectional area (15.13±3.32 mm2) in patients with idiopathic CTS was found to be statistically significantly higher than in patients with CTS+RA (13.26±2.44 mm2) (p=0.048). While there was no difference between CTS groups in terms of sensory electrophysiological measurements, the median nerve motor vii conduction velocity (52.64±6.55 vs 58.97±6.64 m/sec, p<0.001) and median nerve motor amplitude of patients with CTS+ RA ( 4.51±1.05 vs 4.96±0.18 mV, p=0.021) were significantly lower than the idiopathic CTS group. Conclusion: The results of our study show that the cross-sectional area of the median nerve has poor diagnostic potential in CTS in patients with RA and is not correlated with disease activity. In these patients, it seems more appropriate to use USG to elucidate the pathophysiology and to evaluate the anatomical structure of the region.
In this study, we aimed to investigate the relationship of median nerve cross-sectional area with electrophysiological measurements and disease activity in rheumatoid arthritis patients. Material and Methods: Thirty rheumatoid arthritis (RA) patients diagnosed with carpal tunnel syndrome (CTS) by clinical and electrophysiological examinations, 30 RA patients without CTS and 30 idiopathic CTS control groups were included in the study. Age, gender, BMI, disease duration, medications, RF, anti CCP, ESR and CRP values of the patients were recorded. Disease activity in patients with RA was evaluated with DAS-28. The Boston CTS questionnaire was used for the symptom severity and functional evaluation of the patients. Health Assessment Questionnaire (HAQ) was used to measure the health-related quality of life. Ultrasonographic median nerve cross-sectional area (MSCA) was measured at the level of the proximal carpal tunnel of all participants. The patients were evaluated neurophysiologically no later than one week after they were evaluated with USG Results: The mean age of the group with CTS+ RA was found to be significantly higher than the other two groups (p=0.023). There was no difference between the groups in terms of other sociodemographic data. While the sex, RA drugs used, RF and anti-CCP positivity and DAS-28 scores of the CTS+ and CTS- groups with a diagnosis of RA were similar, the median nerve cross-sectional area (12.95±2.35 vs 9.45±2 .47 mm2, p<0.001) and HAQ scores (1.22±0.58 vs 0.80±0.62, p=0.006) of the patients with CTS+ RA were found to be statistically significantly higher. When the groups with CTS were compared with each other, there was no difference between the groups in terms of BMI, duration of CTS, Boston symptom severity score, Boston functional status score and HAQ scores. Median nerve cross-sectional area (15.13±3.32 mm2) in patients with idiopathic CTS was found to be statistically significantly higher than in patients with CTS+RA (13.26±2.44 mm2) (p=0.048). While there was no difference between CTS groups in terms of sensory electrophysiological measurements, the median nerve motor vii conduction velocity (52.64±6.55 vs 58.97±6.64 m/sec, p<0.001) and median nerve motor amplitude of patients with CTS+ RA ( 4.51±1.05 vs 4.96±0.18 mV, p=0.021) were significantly lower than the idiopathic CTS group. Conclusion: The results of our study show that the cross-sectional area of the median nerve has poor diagnostic potential in CTS in patients with RA and is not correlated with disease activity. In these patients, it seems more appropriate to use USG to elucidate the pathophysiology and to evaluate the anatomical structure of the region.
Açıklama
Anahtar Kelimeler
Romatoid artrit, Karpal tünel sendromu, Ultrasonografi, Elektromyografi, Rheumatoid arthritis, Carpal tunnel syndrome, Ultrasonography, Electromyography
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Scopus Q Değeri
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Künye
Özden, H. Ç. (2022). Romatoid artrit hastalarında ultrasonografik median sinir kesit alanının elektrofizyolojik ölçümler ve hastalık aktivitesi ile ilişkisinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Konya.
