Sonographic Evaluation of Lower-limbs Entheses in Subclinical Patients Undergoing Hemodialysis

關節超音波於無關節症狀血液透析病人之下肢接骨點評估

林正輝(Cheng-Hui Lin) ； 項正川(Jeng-Chuan Shiang) ； 蔡明凱(Ming-Kai Tsai) ； 張棋楨(Chi-Ching Chang) ； 張德明(Deh-Ming Chang)

《Formosan Journal of Rheumatology》 26卷1&2期 (2012/12) Pp. 41-48

https://doi.org/10.6313/FJR.2012.26(1-2).06

摘要

Objective: To survey the prevalence of entheseal abnormality in the lower limbs in subclinical patients undergoing hemodialysis by musculoskeletal ultrasound (MSUS), rate the severity of abnormalities using the Glasgow Ultrasound Enthesitis Scoring system (GUESS), and correlate the score with other clinical factors.Methods: Forty-eight subclinical patients who had undergone hemodialysis for at least 4 months were divided into 2 groups. The groups were compared for the total GUESS score, thickness score, erosion score, enthesophyte score, and bursitis score. We then assessed the correlations between these scores and the duration of dialysis, sex, age, body mass index (BMI), and levels of serum biomarkers.Results: The duration of hemodialysis was found to be significantly correlated with the total GUESS score (p＜0.001, r = 0.88) and enthesophyte score (p＜0.001, r = 0.71). No significant correlation was detected between the scores and the following variables: age; sex; BMI; calcium-phosphorus product; and serum levels of calcium, phosphorous, parathormone, uric acid, triglycerides, cholesterol, and C-reactive protein. The prevalence of bilateral lower limb enthesopathy, determined on the basis of grayscale musculoskeletal ultrasound examination, was 21.8%.Conclusion: Hemodialysis patients may develop lower limb enthesopathy, which worsens with increase in the duration of hemodialysis, even in the absence of obvious clinical symptoms or signs. MSUS should be more widely employed by clinicians for the early diagnosis of enthesopathy in subclinical hemodialysis patients.

關鍵字

血液透析 ； 接骨點病變

並列摘要

Objective: To survey the prevalence of entheseal abnormality in the lower limbs in subclinical patients undergoing hemodialysis by musculoskeletal ultrasound (MSUS), rate the severity of abnormalities using the Glasgow Ultrasound Enthesitis Scoring system (GUESS), and correlate the score with other clinical factors.Methods: Forty-eight subclinical patients who had undergone hemodialysis for at least 4 months were divided into 2 groups. The groups were compared for the total GUESS score, thickness score, erosion score, enthesophyte score, and bursitis score. We then assessed the correlations between these scores and the duration of dialysis, sex, age, body mass index (BMI), and levels of serum biomarkers.Results: The duration of hemodialysis was found to be significantly correlated with the total GUESS score (p＜0.001, r = 0.88) and enthesophyte score (p＜0.001, r = 0.71). No significant correlation was detected between the scores and the following variables: age; sex; BMI; calcium-phosphorus product; and serum levels of calcium, phosphorous, parathormone, uric acid, triglycerides, cholesterol, and C-reactive protein. The prevalence of bilateral lower limb enthesopathy, determined on the basis of grayscale musculoskeletal ultrasound examination, was 21.8%.Conclusion: Hemodialysis patients may develop lower limb enthesopathy, which worsens with increase in the duration of hemodialysis, even in the absence of obvious clinical symptoms or signs. MSUS should be more widely employed by clinicians for the early diagnosis of enthesopathy in subclinical hemodialysis patients.

並列關鍵字

Musculoskeletal ultrasound ； enthesopathy ； hemodialysis