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Master Thesis

Intérêt de l’Echographie Articulaire dans le Lupus Erythémateux Systémique en Pratique Courante

Abstract : Introduction: musculoskeletal symptoms are among the most common manifestations of systemic lupus erythematosus (SLE). They strongly participate in the morbidity of the disease. The description of the main ultrasound abnormalities has been known for about ten years. However, the use of joint ultrasound has not developed as much as in rheumatoid arthritis (RA). Objective: the aim of the study was to assess the usefulness in the current practice of joint ultrasound in SLE patients. Methods: nineteen SLE patients and 19 RA patients with present or past musculoskeletal symptoms were recruited. The medical history and the different biology were collected for each patient. All were examined during hospitalization or a routine consultation. Ultrasound (US) of the hands and wrists was performed as a therapeutic decision support tool. Results: SLE patients had few swollen joints of the hands and wrists (Swollen-Tender ratio of 0.25 versus 0.59 for RA). Ultrasound showed positive Power Doppler abnormalities (PD+) in 8 of 19 SLE patients. Six of these patients had neither significant morning stiffness nor the presence of at least two palpable synovitis. For RA, only one of the 17 patients with PD+ abnormalities met neither of the above criteria. Moreover, PD+ abnormalities were found in only 40% of SLE patients with clinical inflammatory manifestations. Ultrasound abnormalities were not significantly correlated with SLEDAI (p=0.8613), but overall they were with DAS28-CRP (r=0.388, p=0.00014) and finally with CRP (r=0.137, p=0). In contrast, unlike RA, negative Power Doppler abnormalities (PD-) were also found in the presence of a biological inflammatory syndrome (r=0.043, p=0). Conclusion: this study proposes an US examination of the hands and the wrists as a fast and more reliable way than physical examination to judge «joint involvement» in SLE patient. It also raises the possibility of expression of the disease activity by a large number of US abnormalities without Power Doppler signal. Due to its polymorphism and its impact, joint involvement should require this early diagnostic precision before introducing a therapy or evaluating its efficacy in clinical trials.
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https://dumas.ccsd.cnrs.fr/dumas-03011959
Contributor : Médecine Ub <>
Submitted on : Wednesday, November 18, 2020 - 12:42:03 PM
Last modification on : Saturday, December 19, 2020 - 3:12:50 AM
Long-term archiving on: : Friday, February 19, 2021 - 7:24:58 PM

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  • HAL Id : dumas-03011959, version 1

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Claire-Sophie Coste. Intérêt de l’Echographie Articulaire dans le Lupus Erythémateux Systémique en Pratique Courante. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03011959⟩

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