Sinovitis de rodilla soriásica y reumatoide. (Inglés)

"Sinovitis de rodilla soriárica y reumatoide: clínica, escala grey y poder de valoración de la ecografía Doppler en la respuesta al etanercept."

Fiocco U, Ferro F, Vezzu M, Cozzi L, Checchetto C, Sfriso P, Botsios C, Ciprian L, Armellin G, Nardacchione R, Piccoli A, Todesco S, Rubaltelli L.

Multidisciplinary Day Surgery Departement, Padua General Hospital, Italy.

OBJECTIVE:
To determine the effect of tumor necrosis factor (TNFa) blockade with etanercept in Rheumatoid (RA) and Psoriatic (PsA) refractory knee joint synovitis (KJS), by local and systemic disease activity and combined gray-scale and power Doppler (PD) ultrasonography (US) monitoring.

METHODS:
27 knees affected by RA-KJS (patients n.12) and PsA-KJS (patients n.8) were assessed before receiving treatment and at 3 and 12 months follow-up. Time-dependent clinical changes in disease activity were monitored by C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Global Health Status (GHS), Ritchie (RAI) and Knee Articular (KAI) Indexes, and these in synovial changes with US and PD indexes for gray-scale synovial thickening and for distinct intrasynovial vessel PD flow configurations: Fluid/Synovium Interface (F/SI-PD) and Pannus/Cartilage Interface (P/CI-PD). Gray-scale and PD US inter- and intra-observer variability was evaluated. Response to therapy was assessed by analysis of variance for repeated measures on clinical and US variables.

RESULTS:
Rapid (3 months) reduction of F/SI-PD flow (p<0.001) parallel to that of CRP (p<0.05), ESR (p<0.001), KJAI (p<0,002), RAI and GHS (p<0.001), was sustained at 12 months, when accompanied by reduction of both synovial thickening and P/CI-PD flow (p<0.001). No differences (ANOVA) were noted at baseline and 12 months in clinical and US variables of RA- and PsA- KJS groups.

CONCLUSION
Gray-scale and PD US are reliable measures of long term changes in rheumatoid and psoriatic KJS disease activity in response to anti-TNFa biologic treatment with etanercept.

Ann Rheum Dis. 2004 Nov 26.