Técnicas de imagen en patología osteomuscular en el lupus eritematoso sistémico

Resumo

Joint involvement in SLE is the most frequent manifestation and shows a wide heterogeneity. It has not a valid classification and it is usually underestimated, when studied by plain radiography. Subclinical inflammatory musculoskeletal (MSK) involvement is not well known. High resolution imaging technics show a high prevalence of inflammatory abnormalities. Some studies by ultrasound (US) have been made, but studies by magnetic resonance imaging (MRI) are very rare Moreover, clinical, demographical and serological clusters related to MSK abnormalities are not well stablished. These alterations are known to be related to pain, fatigue and functional disability, and the latest contribute to health-related quality of life (HRQoL) related to SLE; its impact on health-related quality of life has not been well stablished in these patients either. In this doctoral project we aim to: - Describe the prevalence of joint and tendon involvement in hand and wrist of SLE patients, either with clinical arthritis, arthralgia or asymptomatic and compare it with healthy subjects using contrasted MRI. - Determinate if there is a demographic, clinic or serological profile related to inflammatory joint involvement evaluated by contrasted MRI. - Study the relation between joint and tendon involvement confirmed by contrasted MRI and these patient related outcomes (PRO). - Evaluate the long-term prognosis of patients with US abnormalities at baseline in a prospective study We found SLE patients to have a high prevalence of inflammatory musculoskeletal alterations by contrasted MRI, even if asymptomatic. Not only tenosynovitis but peritendonitis is also present. When MSK alterations are present in MRI, patients are mainly older and have less renal involvement, receiving more methotrexate (MTX) and less mycophenolate than those who do not have MSK involvement. Also, they have a worse HRQoL measured by pain, fatigue and functional disability. When US abnormalities are found and followed during time (6 years), patients affected by MSK symptoms receive more immunosuppressants (MTX), describing a specific long-term outcome. This work highlights, not only the high prevalence of inflammatory abnormalities identified by high resolution imaging tests in SLE patients, but also a different outcome, which should lead clinicians to be more aware about these patients and if possible, confirm these data in larger cohorts.