AB1179 TYPES OF JOINT LESIONS IN REACTIVE ARTHROPATHY
Authors: Volha Sirotka, Uladzimir Sirotka, Alexander Litvyakov
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Differential diagnosis of ReA has certain difficulties, especially at an early stage in the absence of confirmation of trigger infection. Radiographic signs of joint damage when the response are not specific and appear not earlier than 3-6 months from the onset of the disease; enthesitis this method is not visualized, making it difficult to timely diagnosis of ReA [1]. To determine the tactics of patient management and selection of adequate therapy is no less important to determine the duration and characteristics of the course of ReA. <h3>Objectives</h3> To study the ultrasonic features of joint lesions in reactive arthropathy depending on the course of the disease. <h3>Methods</h3> We examined 66 patients with Rea who met the preliminary international criteria were examined (4th International Workshop on Reactive Arthritis, Berlin 1999). Women were 26 (39%), men - 40 (61%), median age - 34 years (31-42), median duration of ReA- 1 year (0.3-3.25). Among the patients there were 40 (61%) people with acute ReA and 26 (39%) people with chronic ReA. All patients had confirmed chlamydial infection (PCR and IFA). Patients underwent a comprehensive clinical and laboratory examination, MRI and ultrasound of the knee joints. Statistical processing of the information package. <h3>Results</h3> The MRI of the affected joints clearly visualized inflamed entheses and the presence of local osteitis with an erosive defect of the closing plate of the bone (Fig.1). In patients with acute ReA were visualized: thickening of entheses more than 3 mm (98%), hypo-, anechogenic areas in the projection of the tendon-ligamentous apparatus and places of its fixation (74%), the formation of a bone defect under them with a contour of reduced echogenicity (erosion of acute inflammation - 66,8%) and uneven edges, pronounced effusion (75%), lack of strengthening of local blood flow in the projection of synovia and joint structures (Fig.2). In patients with chronic ReA, the following were visualized: thickening of entheses to 3 mm (65%), hyperechogenic inclusions in the projection of the tendon-ligamentous apparatus and its fixation sites (53%), the formation of a bone defect under them with a contour of increased echogenicity (erosion of chronic inflammation – 46,9%) and uneven edges, slight effusion (28%), the absence of strengthening of local blood flow in the projection of synovia and joint structures (Fig.3). All patients with ReA were found to have a positive "pain test" in palpation of the affected entheses under the control of ultrasound entesopathy. <h3>Conclusion</h3> Based on the results we have made the following conclusions: 1.Ultrasound of joints allows to identify and assess the nature of joint lesions depending on the duration of the ReA. 2.Ultrasound criteria of acute ReA: enthesitis, erosion acute inflammation under affected entheses, enthesopathy expressed by secondary synovitis. 3. Ultrasound criteria for the chronic course of ReA: enthesitis, erosion of chronic inflammation under the affected entheses, enthesopathy, minor secondary synovitis, calcinates. <h3>References</h3> [1] 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative/D. Aletaha [et al.]//Ann. Rheum. Dis. – 2010. – Vol. 69. – P. 1580-1588. [2] Sirotka, V. Clinico-tool differential diagnostics erosive lesions of joints at patients with rhematoid and reactive arthritis/V. Sirotka, A. Litvyakov//VEDECKY PRUMYSL EVROPSKENO KONTINENTU-2013: materialy IX mezinarodni vedecko-prakticka conference, Praha, 27 listopadu - 05 prosincu 2013 rocu/Praha Publishing House «Education and Science». – Praha, –2013. –P. 23-24. <h3>Disclosure of Interests</h3> None declared