| Sažetak | Cilj istraživanja. Radiografskim i sonografskim pretragama zabilježiti morfološke promjene bolnoga ramena u reumatoidnom artritisu i u bolnom ramenu neupalne etiologije. Potom parametre pacijenata s bolnim ramenom u reumatoidnom artritisu usporediti s parametrima pacijenata s bolnim ramenom neupalne etiologije. Ustroj istraživanja. Presječna studija. Analizirane su dvije skupine pacijenata: pacijenti koji boluju od bolnoga ramena u reumatoidnom artritisu i pacijenti koji imaju bolno rame neupalne etiologije. U pacijenata s reumatoidnim artritisom analiziran je konvencionalni radiogram i obavljen ultrazvučni pregled oba ramena, a u pacijenata s neupalnom etiologijom dijagnostika je obavljena jednostrano. Usporedili smo nalaze pacijenata s bolnim ramenom u reumatoidnom artritisu s parametrima pacijenata s bolnim ramenom neupalne etiologije. Mjesto istraživanja. Klinički zavod za dijagnostičku i intervencijsku radiologiju Kliničkog bolničkog centra Split; Split; Hrvatska. Pacijenti i postupci. Studija je provedena na 40 pacijenata s dokazanim reumatoidnim artritisom i 80 pacijenata s bolnim ramenom bez evidencije o reumatoidnom artritisu. U pacijenata s reumatoidnim artritisom obavljena je dijagnostika obaju ramena, a u pacijenata s neupalnom etiologijom jednostrano. Uz pomoć mentora, analizirao sam i obradio podatke iz specijalističkih nalaza dobivenih uvidom u dokumentaciju pismohrane i filmoteke Kliničkog zavoda za dijagnostičku i intervencijsku radiologiju. Za svako rame analizirani su: debljina tetive supraspinatusa, debljina tetive duge glave bicepsa, udaljenost zglobna ovojnica-kost, izljev u ovojnici duge glave bicepsa, izljev u subdeltoidnoj burzi, difuzna osteopenija, kalcifikacije rotatorne manšete, inhomogenicitet rotatorne manšete, djelomična ruptura rotatorne manšete, potpuna ruptura rotatorne manšete, sklerozacija velikog tuberkuluma, subakromijalni osteofiti, osteoartritis akromioklavikularnog zgloba i osteoartritis humeroskapularnog zgloba. Za utvrđivanje statistički značajne razlike među numeričkim parametrima korišten je T test. Korelacija između kategorijskih varijabli utvrđena je χ2 testom.
Rezultati. Naše istraživanje pokazalo je da je udaljenost zglobna kapsula-kost (indikator količine intraartikularne sinovijalne tekućine) značajno veća u bolesnika s reumatoidnim artritisom nego u skupini bolesnika s bolnim ramenom neupalne etiologije. Značajno više bolesnika s reumatoidnim artritisom imalo je izljev u ovojnicu tetive duge glave bicepsa i izljev u subdeltoidnoj burzi. U značajno većeg broja bolesnika s bolnim ramenom neupalnog uzroka nađeni su subakromijalni osteofiti u odnosu na bolesnike s reumatoidnim artritisom. Ostali analizirani parametri bili su bez statistički značajne razlike. Zaključak. Uzure kosti, intraartikularni izljevi, te izljevi u subdeldoidnoj burzi i ovojnici tetive duge glave bicepsa predominantno su vezani za RA, dok su osteoartritis akromioklavikularnog zgloba i subakromijalni osteofiti predminantno vezani za bolno rame neupalne etiologije. Kalcifikacije i inhomogenicitet rotatorne manšete, djelomične i potpune rupture pojavljuju se gotovo podjednako u skupini bolesnika s reumatoidnim artritisom i u skupini s bolnim ramenom neupalne etiologije. To ističe multifaktorijalnost bolnoga ramena bolesnika s reumatoidnim artritisom. Očigledno, ti bolesnici nisu “zaštićeni” od ostalih štetnih utjecaja koji se vide kod starijih osoba. Zato je za procjenu terapije poslije kliničke prosudbe potrebna morfološka analiza ramena. Različita kombinacija morfoloških parametara ramena implicira individualni pristup terapiji. |
| Sažetak (engleski) | Objective. In our study, we examined both radiographic and sonographic findings to record the morphological changes of the patients with painful shoulder in rheumatoid arthritis as well as patients with painful shoulder with non-inflammatory etiology. Then the parameters of patients with painful shoulder in rheumatoid arthritis were compared with parameters of the patients with non-inflammatory etiology of the painful shoulder. Design. We performed a cross-sectional study. Two groups of patients were analyzed: patients with painful shoulder in rheumatoid arthritis and patients with non-inflammatory etiology of painful shoulder. We analyzed the findings of the radiographic and sonographic examination of both shoulders in patients with rheumatoid arthritis, and in patients with non-inflammatory etiology diagnostics was performed unilaterally. We compared the findings of patients with painful shoulder in rheumatoid arthritis with parameters of patients with non-inflammatory etiology of painful shoulder. Settings. Department of Diagnostic and Interventional Radiology, Clinical Hospital Split, Split, Croatia. Patients and methods. The study was conducted on 40 patients with proven rheumatoid arthritis and 80 patients with painful shoulder with no evidence of rheumatoid arthritis. Diagnostics was performed on both shoulders in patients with rheumatoid arthritis and unilaterally in patients with non-inflammatory etiology. With the help of my mentor, I reviewed and analyzed data from the specialist findings obtained by examining the documents and film archives of the Clinical Institute of Diagnostic and Interventional Radiology. For each shoulder we analyzed: thickness of supraspinatus tendon, thickness of biceps tendon, capsule-bone distance, effusion of the biceps tendon sheath, subdeltoid bursa effusion, diffuse osteopenia, calcification of the rotator cuff, inhomogenity of the rotator cuff, partial rotator cuff tear, complete rupture of the rotator cuff, large tuberculum sclerosis, subacromial osteophytes, acromioclavicular joint osteoarthritis and osteoarthritis of the humeroscapular joint. To determine statistically significant differences between the numerical parameters we used the T test. The correlation between categorical variables was determined by χ2 test.
Results. Our research has shown that the capsule-bone distance (an indicator of the intraarticular synovial fluid) was significantly bigger in patients with rheumatoid arthritis than in patients with non-inflammatory etiology of the painful shoulder. Significantly more patients with rheumatoid arthritis had an effusion of the biceps tendon sheath and a subdeltoid bursa effusion. The significantly larger number of patients with painful shoulder with non-inflammatory etiology had subacromial osteophytes in comparison to patients with rheumatoid arthritis. Other analyzed parameters were not significantly different. Conclusion. Bone erosions, intraarticular effusions, subdeltoid bursa effusions and effusions of the biceps tendon sheath are predominantly associated with rheumatoid arthritis, while osteoarthritis of the acromioclavicular joint and the subacromial osteophytes are predominantly related to non-inflammatory etiology of the painful shoulder. Calcifications and inhomogenity of the rotator cuff, as well as partial and complete ruptures occur almost equally in the group of patients with rheumatoid arthritis and with non-inflammatory etiology of the painful shoulder. It emphasizes the multifactoriality of the painful shoulder patients with rheumatoid arthritis. Obviously, these patients are not "protected" from the other harmful effects that are seen in the elderly population. Therefore, the assessment of the therapy after the clinical exam requires a morphological analysis of the shoulder. Different combinations of the morphological parameters of the painful shoulder imply an individual approach to the therapy. |
