Romatoid artritli hastalarda hastalık aktivitesi ile gastroknemius kas sertliği arasındaki ilişki
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Romatoid artrit; etyolojisi net bilinmeyen, simetrik, inflamatuar, periferik bir poliartrittir. Tipik olarak
kıkırdak ve kemik erozyonu yoluyla eklem tahribatına yol açar. RA hastalarında %25-70 oranında kas zayıflığı
ve düşük kas yoğunluğu izlenmektedir. RA’daki miyopatik özellikleri tanımlamak ve araştırmak amacıyla
invazif olmayan kantitatif yöntemlerin kullanımı son yıllarda artış göstermeye başlamış olsa da bu yöntemler
henüz yaygınlaşmamış ve standart bir değerlendirme aracı haline gelmemiştir. RA’da kasların biyomekanik
durumuna yeni bir bakış açısı sunabilen ultrason kayma dalgası elastografisi (SWE) kullanılarak kaslar invazif
olmayan bir şekilde değerlendirilebilir. Bu çalışma RA tanılı hasta grubu ile sağlıklı kontrol grubu
karşılaştırıldığında, hastalık aktivitesi ile gastroknemius kas sertliği arasında nasıl bir ilişki olduğunu anlamayı
amaçlamıştır.
Yöntem: Çalışmaya Necmettin Erbakan Üniversitesi Tıp Fakültesi Romatoloji kliniğine başvuran RA tanısı
olan 60 hasta ve 60 sağlıklı kontrol grubu dahil edilmiştir. RA tanılı hastalar DAS28-CRP hastalık aktivite
skoruna göre gruplandırılmıştır ve sağlıklı kontrol grubu ile karşılaştırılmıştır. Hastalık aktivitesine göre
gruplandırılan hastaların ve kontrol grubunun usg cihazı ile gastroknemius kas sertliğine bakılmıştır. Çalışma
SGK kapsamında olmayan bağış usg cihazıyla yapılmıştır. Ultrasonda SWE tekniği kullanılarak gastroknemius
kas sertliği ölçülmüştür. Hasta ve kontrol grubun boy ve kiloları ölçülerek vücut kitle indeksi hesaplanmıştır.
Hasta ve kontrol grubun rutinde bakılan kan tetkikleri yapılmıştır. Hasta ve kontrol grubuna fiziksel aktivitenin
değerlendirilebilmesi açısından uluslararası fiziksel aktivite anketi olan IPAQ (kısa) anketinin doldurulması
istenmiştir.
Bulgular: RA tanısı almış 60 hasta ve sağlıklı 60 kontrol grubu ile yürütülen çalışmamızda hastaların tümü
kadındır. RA grubunun yaş ortalaması 49,71±8,81 yıl, sağlıklı kontrol grubunun yaş ortalaması 47,29±5,18
yıldır. RA grubunun VKİ ortalaması 29,00±4,55 kg/m2, sağlıklı kontrol grubunun VKİ ortalaması 28,97±6,59
kg/m2’dir. Gruplar arasında fiziksel aktivite düzeyi açısından bir fark yoktur (p>0,05). Gruplar arasında
biyokimyasal parametreler karşılaştırıldığında lökosit, nötrofil, total protein, albümin, ESH ve CRP açısından
anlamlı fark olduğu bulundu (p<005). Gastroknemius kas kalınlığı ve sertliği ölçüm sonuçlarının gruplar
arasında karşılaştırılması sonucunda RA’lı bireylerin sağ ve sol medial gastroknemius kas kalınlıkları sağlıklı
bireylere göre düşük bulundu (p=0,001, p=0,016). RA’lı bireylerin sol medial gastroknemius kas sertliğinin
sağlıklı bireylere göre yüksek olduğu bulundu (p=0,028). RA hastalarında gastroknemius kası kalınlığı ve
sertliği ile klinik özellikler arasındaki ilişki incelendiğinde sağ ve sol medial gastroknemius kası kalınlığı ile
ESH değeri arasında negatif yönlü ve anlamlı bir ilişki olduğu, sol gastroknemius kas sertliği ve ESH değeri
arasında ise pozitif yönde anlamlı bir ilişki olduğu bulundu (p<0,05). DAS28-CRP skoru ile hastalık
aktivitesine göre sınıflandırılan RA hastalarının gastroknemius kası kalınlığı ve sertliğinin karşılaştırılması
sonucunda remisyon/düşük hastalık aktivitesi olan RA hastalarında orta düzeyde hastalık aktivitesi olan RA
hastalarına göre sol medial ve lateral gastroknemius kas kalınlıklarının daha fazla olduğu bulundu (p=0,048,
p=0,042). Remisyon/düşük hastalık aktivitesi olan RA hastalarında orta düzeyde hastalık aktivitesi olan RA
hastalarına göre sağ medial ve lateral gastroknemius ve sol lateral gastroknemius kas sertliklerinin daha fazla
olduğu bulundu (p<0,05).
Sonuç: Bu çalışmada romatoid artritli bireylerde gastroknemius kasının kalınlık ve sertlik özellikleri kayma
dalgası elastografisi (SWE) ile değerlendirilmiş ve sağlıklı bireylerle karşılaştırılarak hastalık aktivitesi ile
ilişkisi incelenmiştir. RA grubunda kas kalınlığı azalmış, sertlik ise artmıştır. Kas parametreleri ile ESH
düzeyleri arasında anlamlı korelasyonlar bulunurken CRP ve DAS28-CRP ile istatistiksel anlamlı bir ilişki
bulunmamıştır. Düşük hastalık aktivitesine sahip bireylerde kas kalınlığı korunurken kasın bazı bölgelerinde
sertlik artışı dikkat çekmiştir. Bulgular RA’nın inflamasyonun ötesine geçerek kas dokusunda yapısal
değişikliklere yol açtığını ve SWE’nin bu değişimleri non-invaziv şekilde saptamada etkili olduğunu
göstermektedir. Ayrıca kas sertliğinin yalnızca inflamasyon değil, postürel ve biyomekanik faktörlerden de
etkilenebileceği kanaatine varılmıştır. Remisyon grubunda gözlenen daha iyi kas kalınlığı değerlerinin olası
biyolojik ajan kullanımı ile ilişkili olabileceği düşünülmüştür. Bu durum biyolojik tedavilerin kas sağlığı
üzerinde potansiyel olumlu etkileri olabileceğini gündeme getirmektedir.
Objective: Rheumatoid arthritis (RA) is a symmetric, inflammatory, peripheral polyarthritis of unknown etiology. It typically leads to joint destruction through cartilage and bone erosion. In RA patients, muscle weakness and low muscle density are observed in approximately 25–70% of cases. Although the use of noninvasive quantitative methods to define and investigate the myopathic features of RA has increased in recent years, these methods have not yet become widespread or established as standard assessment tools. Shear wave elastography (SWE), an ultrasound-based technique that offers a new perspective on the biomechanical status of muscles in RA, enables the non-invasive evaluation of muscles. This study aimed to investigate the relationship between disease activity and gastrocnemius muscle stiffness by comparing a group of patients diagnosed with RA to a healthy control group. Method: The study included 60 patients diagnosed with RA who presented to the Rheumatology Clinic of Necmettin Erbakan University Faculty of Medicine and 60 healthy control groups. RA patients were grouped according to the DAS28-CRP disease activity score and compared with the healthy control group. Gastrocnemius muscle stiffness was evaluated using an ultrasound device in both the patient groups (classified by disease activity) and the control group. The study was conducted using a donated ultrasound device that was not covered by the Social Security Institution (SGK). Gastrocnemius muscle stiffness was measured using the shear wave elastography (SWE) technique on ultrasound. The height and weight of both the patient and control groups were measured, and body mass index (BMI) was calculated. Routine blood tests were performed for both groups. Additionally, both the patient and control groups were asked to complete the International Physical Activity Questionnaire (IPAQ-short form) in order to assess their level of physical activity. Results: In our study conducted with 60 patients diagnosed with RA and 60 healthy control subjects, all participants were female. The mean age of the RA group was 49.71±8.81 years, while the mean age of the healthy control group was 47.29±5.18 years. The mean BMI of the RA group was 29.00±4.55 kg/m², and the mean BMI of the healthy control group was 28.97±6.59 kg/m². There was no significant difference in physical activity levels between the groups (p>0.05). When comparing biochemical parameters between the groups, significant differences were found in leukocyte count, neutrophil count, total protein, albumin, ESR, and CRP levels (p<0.05). As a result of comparing the gastrocnemius muscle thickness and stiffness measurements between the groups, it was found that the right and left medial gastrocnemius muscle thicknesses of individuals with RA were lower than those of healthy individuals (p=0.001, p=0.016). The left medial gastrocnemius muscle stiffness of individuals with RA was found to be higher than that of healthy individuals (p=0.028). When examining the relationship between gastrocnemius muscle thickness and stiffness and clinical features in RA patients, a significant negative correlation was found between the right and left medial gastrocnemius muscle thickness and ESR value, while a significant positive correlation was found between left gastrocnemius muscle stiffness and ESR value (p<0.05). Conclusion: In this study, the thickness and stiffness properties of the gastrocnemius muscle in individuals with rheumatoid arthritis were evaluated with shear wave elastography (SWE) and compared with healthy individuals to examine the relationship with disease activity. In the RA group, muscle thickness decreased and stiffness increased. While significant correlations were found between muscle parameters and sedimentation levels, no statistically significant relationship was found with CRP and DAS28-CRP. While muscle thickness was preserved in individuals with low disease activity, an increase in stiffness was noted in some areas of the muscle. The findings show that RA goes beyond inflammation and causes structural changes in muscle tissue and SWE is effective in detecting these changes non-invasively. In addition, it was concluded that muscle stiffness may be affected not only by inflammation but also by postural and biomechanical factors. It was thought that the better muscle thickness values observed in the remission group may be related to the possible use of biological agents. This situation brings to the agenda the potential positive effects of biological treatments on muscle health.
Objective: Rheumatoid arthritis (RA) is a symmetric, inflammatory, peripheral polyarthritis of unknown etiology. It typically leads to joint destruction through cartilage and bone erosion. In RA patients, muscle weakness and low muscle density are observed in approximately 25–70% of cases. Although the use of noninvasive quantitative methods to define and investigate the myopathic features of RA has increased in recent years, these methods have not yet become widespread or established as standard assessment tools. Shear wave elastography (SWE), an ultrasound-based technique that offers a new perspective on the biomechanical status of muscles in RA, enables the non-invasive evaluation of muscles. This study aimed to investigate the relationship between disease activity and gastrocnemius muscle stiffness by comparing a group of patients diagnosed with RA to a healthy control group. Method: The study included 60 patients diagnosed with RA who presented to the Rheumatology Clinic of Necmettin Erbakan University Faculty of Medicine and 60 healthy control groups. RA patients were grouped according to the DAS28-CRP disease activity score and compared with the healthy control group. Gastrocnemius muscle stiffness was evaluated using an ultrasound device in both the patient groups (classified by disease activity) and the control group. The study was conducted using a donated ultrasound device that was not covered by the Social Security Institution (SGK). Gastrocnemius muscle stiffness was measured using the shear wave elastography (SWE) technique on ultrasound. The height and weight of both the patient and control groups were measured, and body mass index (BMI) was calculated. Routine blood tests were performed for both groups. Additionally, both the patient and control groups were asked to complete the International Physical Activity Questionnaire (IPAQ-short form) in order to assess their level of physical activity. Results: In our study conducted with 60 patients diagnosed with RA and 60 healthy control subjects, all participants were female. The mean age of the RA group was 49.71±8.81 years, while the mean age of the healthy control group was 47.29±5.18 years. The mean BMI of the RA group was 29.00±4.55 kg/m², and the mean BMI of the healthy control group was 28.97±6.59 kg/m². There was no significant difference in physical activity levels between the groups (p>0.05). When comparing biochemical parameters between the groups, significant differences were found in leukocyte count, neutrophil count, total protein, albumin, ESR, and CRP levels (p<0.05). As a result of comparing the gastrocnemius muscle thickness and stiffness measurements between the groups, it was found that the right and left medial gastrocnemius muscle thicknesses of individuals with RA were lower than those of healthy individuals (p=0.001, p=0.016). The left medial gastrocnemius muscle stiffness of individuals with RA was found to be higher than that of healthy individuals (p=0.028). When examining the relationship between gastrocnemius muscle thickness and stiffness and clinical features in RA patients, a significant negative correlation was found between the right and left medial gastrocnemius muscle thickness and ESR value, while a significant positive correlation was found between left gastrocnemius muscle stiffness and ESR value (p<0.05). Conclusion: In this study, the thickness and stiffness properties of the gastrocnemius muscle in individuals with rheumatoid arthritis were evaluated with shear wave elastography (SWE) and compared with healthy individuals to examine the relationship with disease activity. In the RA group, muscle thickness decreased and stiffness increased. While significant correlations were found between muscle parameters and sedimentation levels, no statistically significant relationship was found with CRP and DAS28-CRP. While muscle thickness was preserved in individuals with low disease activity, an increase in stiffness was noted in some areas of the muscle. The findings show that RA goes beyond inflammation and causes structural changes in muscle tissue and SWE is effective in detecting these changes non-invasively. In addition, it was concluded that muscle stiffness may be affected not only by inflammation but also by postural and biomechanical factors. It was thought that the better muscle thickness values observed in the remission group may be related to the possible use of biological agents. This situation brings to the agenda the potential positive effects of biological treatments on muscle health.
Açıklama
Anahtar Kelimeler
romatoid artrit, rheumatoid arthritis, kas sertliği, muscle stiffness, hastalık aktivitesi, disease activity, kayma dalgası elastografisi, shear wave elastography
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Nergiz, Y. (2025). Romatoid artritli hastalarda hastalık aktivitesi ile gastroknemius kas sertliği arasındaki ilişki. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
