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O contributo da mini-artroscopia para o diagnóstico definitivo de sinovite
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Introdução: A membrana sinovial é o principal tecido a ser afetado no contexto de uma artrite. O estudo desta pode ser efetuado através da mini-artroscopia. Apesar do seu conhecido potencial, a extensão do seu contributo para o diagnóstico diferencial da sinovite é incerta, tornando-se, portanto, relevante esclarecer o possível impacto do seu uso. Métodos: O estudo focou-se em mini-artroscopias efetuadas entre outubro de 2010 e março de 2018 (n=47), numa população de 46 pessoas. A base de dados com os registos dos procedimentos foi posteriormente trabalhada. Os diagnósticos pré e pós-miniartroscopia foram caracterizados, tendo-se calculado ainda a correlação entre a presença de cristais na membrana sinovial (MS) e no líquido articular (LA) versus o diagnóstico de artrite microcristalina, e entre a contagem e predomínio celulares do LA versus os tipos de artrite. Resultados: Antes da mini-artroscopia, cerca de 87.2% dos procedimentos tinham como diagnóstico uma artrite a esclarecer. Após a técnica, 94% de todos os procedimentos ficaram com um diagnóstico estabelecido. A suspeita diagnóstica (n=14) foi confirmada em 42.9%, excluída com um novo diagnóstico em 50% e excluída sem um novo diagnóstico em 7.1%. Uma correlação de Phi revelou uma associação positiva entre cristais na MS e LA versus diagnóstico de artrite microcristalina (r=0.844, n=46, p< 0.001 e r=0.340, n=41, p= 0.029, respetivamente). Não foi encontrada uma correlação significativa entre os tipos de artrite e as outras variáveis: celularidade do LA (teste de Kruskal Wallis, Χ2(4) = 7.697, p = 0.103) e predomínio celular (teste Chi-quadrado, Χ2(24) = 27.062, p = 0.302) Conclusões: A mini-artroscopia apresenta características especiais que contribuem para o diagnóstico diferencial das artrites. Não sendo atualmente um exame de rotina, os seus benefícios são relevantes na abordagem diagnóstica, podendo adquirir uma importância acrescida no futuro.
Background: The synovium is the main structure to be affected in an arthritis. It can be approached and studied via mini-arthroscopy. In spite of its known potential, the extent of its contribution on a synovitis’ differential diagnosis is uncertain. Thus, it becomes quite relevant to clarify the influence of its usage. Methods: The paper focuses in 47 mini-arthroscopies carried out between October 2010 and March 2018, in 46 people. The database containing the procedures records was worked on afterwards. The diagnosis pre and post-mini-arthroscopy were characterized. Additionally, the correlation between the presence of crystals in the synovial membrane (SM) and synovial fluid (SF) versus diagnosis of microcrystalline arthritis, and between the SF’s cell count and cell differentiation versus types of arthritis was calculated. Results: Before the mini-arthroscopy, approximately 87.2% of the procedures had an undiagnosed arthritis. After the operation, 94% of all procedures were labeled with an established diagnosis. The diagnostic suspicion was confirmed in 42.9%, ruled out with a new diagnosis in 50% and ruled out without a new diagnosis in 7.1%, with n=14. A Phi correlation revealed a positive association between crystals in the SM and SF versus diagnosis of microcrystalline arthritis (r=0.844, n=46, p< 0.001 e r=0.340, n=41, p= 0.029, respectively). No significant correlation was found between the type of arthritis and the other variables: SF cell count (Kruskal Wallis test, Χ2(4) = 7.697, p = 0.103), and cell differentiation (Chi-squared test, Χ2(24) = 27.062, p = 0.302) Conclusions: The mini-arthroscopy englobes special characteristics that contribute to an arthritis’ differential diagnosis. Not currently being a routine exam, its benefits are relevant to the diagnostic reasoning, which could lead to a more prominent role in the future.
Background: The synovium is the main structure to be affected in an arthritis. It can be approached and studied via mini-arthroscopy. In spite of its known potential, the extent of its contribution on a synovitis’ differential diagnosis is uncertain. Thus, it becomes quite relevant to clarify the influence of its usage. Methods: The paper focuses in 47 mini-arthroscopies carried out between October 2010 and March 2018, in 46 people. The database containing the procedures records was worked on afterwards. The diagnosis pre and post-mini-arthroscopy were characterized. Additionally, the correlation between the presence of crystals in the synovial membrane (SM) and synovial fluid (SF) versus diagnosis of microcrystalline arthritis, and between the SF’s cell count and cell differentiation versus types of arthritis was calculated. Results: Before the mini-arthroscopy, approximately 87.2% of the procedures had an undiagnosed arthritis. After the operation, 94% of all procedures were labeled with an established diagnosis. The diagnostic suspicion was confirmed in 42.9%, ruled out with a new diagnosis in 50% and ruled out without a new diagnosis in 7.1%, with n=14. A Phi correlation revealed a positive association between crystals in the SM and SF versus diagnosis of microcrystalline arthritis (r=0.844, n=46, p< 0.001 e r=0.340, n=41, p= 0.029, respectively). No significant correlation was found between the type of arthritis and the other variables: SF cell count (Kruskal Wallis test, Χ2(4) = 7.697, p = 0.103), and cell differentiation (Chi-squared test, Χ2(24) = 27.062, p = 0.302) Conclusions: The mini-arthroscopy englobes special characteristics that contribute to an arthritis’ differential diagnosis. Not currently being a routine exam, its benefits are relevant to the diagnostic reasoning, which could lead to a more prominent role in the future.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Mini-artroscopia Diagnóstico Sinovite Artrite Reumatologia