Quantificação de lesões agudas e crônicas em ressonância nuclear magnética de sacroilíacas em pacientes com uveíte anterior aguda recorrente: uma prova de conceito

• Ano de defesa: 2016
• Autor(a) principal: Oliveira, Thauana Luiza de [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Spondyloarthritis; Magnetic resonance imaging; Sacroiliac joint; Recurrent acute anterior uveitis; hla-b27; Espondiloartrites; Ressonância nuclear magnética; Sacroilíacas; Uveíte anterior aguda recorrente
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3645989; http://repositorio.unifesp.br/handle/11600/47856

Introduction: Acute anterior uveitis is an inflammation of the middle layer of the eye and is related to human leukocyte antigen B27 (HLA-B27) and the concept of spondyloarthritis (SpA). Objectives: To assess the prevalence of definite SpA by combined T1W/STIR MRI (global MRI), to quantify acute and chronic lesions in SIJ using MRI in patients with rAAU with and without back symptoms, and to assess which MRI lesion-based criteria optimally reflect the global MRI designation of definite SpA. Methods: A total of 50 consecutive patients with rAAU without prior rheumatologic diagnosis were included in this cross-sectional study and were compared to 21 healthy volunteers. They were evaluated for the presence of inflammatory back pain and classified according to modified New York criteria (Nym), ASAS (Assessment on SpondyloArthritis International Society) for axial SpA (ax-SpA) and peripheral (p-SpA), as well as fibromyalgia. Patients underwent radiography (XR) and MRI of the SI according to ASAS recommendations. Both MRI and XR were evaluated independently by two rheumatologists, and the discrepant cases read by a radiologist. The identification and quantification of acute and chronic lesions were performed according to MORPHO/SPARCC (The Spondyloarthritis Research Consortium of Canada) group protocol. The following laboratory tests were also performed: antinuclear antibody (ANA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C- reactive protein (CRP) and HLA-B27. Results: rAAU patients were classified as ax-SpA (Group 1, n=20) according to ASAS criteria (2009); non-specific back pain (Group 2, n=6) and asymptomatic (Group 3, n=24). The groups were similar regarding age, sex, ethnicity, age at onset of uveitis, current uveitis activity and duration of eye disease. HLA-B27 was positive in 48% of those with rAAU. Considering only group 3, nine (37.5%) patients had SIJ MRI and/or X-ray positive for axial SpA (5 MRI and x-ray, 1 MRI, 3 x-ray). MRI scans compatible with SpA in groups 1(n=12) and 3 (n=6) were similar regarding acute and chronic lesions analysed according to MORPHO. The best sensitivity/specificity criterion to define a positive global MRI assessment was bone marrow edema (BME) ? 3 (92%/94%). Conclusions: This is the first study evaluating SIJ MRI in patients with rAUU without back symptoms showing positive findings for sacroiliitis, confirming a uvea-axial spine link, and BME ? 3 as optimal for a positive MRI.