Department of Medical Imaging, Musculoskeletal Imaging Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium.
Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium.
Diagn Interv Imaging. 2021 Sep;102(9):553-559. doi: 10.1016/j.diii.2021.03.005. Epub 2021 Apr 24.
The purpose of this study was to test the hypothesis that Jaccoud arthropathy (JA) in patients with systemic lupus erythematosus (SLE) is associated with instability of the extensor digitorum (ED) tendons during flexion of the metacarpophalangeal (MCP) joints by comparing the position of the ED tendons between SLE patients with JA and control subjects on hand MRI obtained with flexed and extended MCP joints.
Thirty-two hands of SLE patients with JA (13 women and 3 men; mean age, 50.0±12.2 [SD] years; age range: 26-68years) and 24 hands of sex- and age-matched control subjects (20 women and 4 men; mean age, 50.1±13.0 [SD] years; age range: 24-68years) were included in the study. Axial spin echo T1-weighted MRI images of the second to fifth MCP joints in flexion and in extension were obtained. Two radiologists (R1 and R2) separately measured the amplitude and assessed the direction of the displacement of the ED tendons with respect to the midline at the level of each MCP joint. Statistical analysis included two-way ANOVA with random effects to assess differences in amplitude and Fisher-Freeman-Halton exact test to assess differences in direction with P-values<0.0083 and<0.0063 considered as statistically significant respectively.
Amplitude of the displacement of the ED tendons was statistically significantly greater in SLE patients with JA than in control subjects in flexion for both readers (median 58°, 95% confidence interval [CI]: 50°-65° vs. 20°, 95% CI: 16°-24°; P<0.0001 for R1 and 54°, 95% CI: 47°-61° vs. 25°, 95% CI: 22°-28°; P<0.0001 for R2) and in extension for one reader (17°, 95% CI: 15°-20° vs. 14°, 95% CI: 11°-16°; P=0.0048 for R1 and 20°, 95% CI: 15°-25° vs. 16°, 95% CI: 12°-18°; P=0.0292 for R2). Ulnar deviation of the ED tendons was statistically significantly more frequent in SLE patients with JA than in control subjects in flexion and in extension for both readers (P<0.0001).
JA is associated with instability of the ED tendons in patients with SLE best depicted when MCP joints are flexed.
本研究旨在通过比较患有红斑狼疮（SLE）伴 Jac coud 关节病（JA）的患者与对照组在掌指（MCP）关节弯曲和伸展时伸指（ED）肌腱的位置，来验证 JA 患者的 ED 肌腱在 MCP 关节弯曲时不稳定的假设。
研究纳入了 32 只患有 JA 的 SLE 患者的手（13 名女性和 3 名男性；平均年龄 50.0±12.2[SD]岁；年龄范围：26-68 岁）和 24 只匹配性别和年龄的对照组的手（20 名女性和 4 名男性；平均年龄 50.1±13.0[SD]岁；年龄范围：24-68 岁）。对第二至第五 MCP 关节在弯曲和伸展时进行轴向自旋回波 T1 加权 MRI 成像。两名放射科医生（R1 和 R2）分别测量了 ED 肌腱在每个 MCP 关节水平相对于中线的位移幅度和方向。统计分析包括具有随机效应的双因素方差分析，以评估幅度差异，Fisher-Freeman-Halton 精确检验以评估方向差异，P 值<0.0083 和 P 值<0.0063 分别被认为具有统计学意义。
在弯曲时，与对照组相比，SLE 伴 JA 患者的 ED 肌腱位移幅度明显更大，两名放射科医生均有统计学意义（中位数 58°，95%置信区间[CI]：50°-65° vs. 20°，95% CI：16°-24°；R1，P<0.0001；中位数 54°，95% CI：47°-61° vs. 25°，95% CI：22°-28°；R2，P<0.0001），在伸展时，一名放射科医生有统计学意义（中位数 17°，95% CI：15°-20° vs. 14°，95% CI：11°-16°；R1，P=0.0048），另一名放射科医生无统计学意义（中位数 20°，95% CI：15°-25° vs. 16°，95% CI：12°-18°；R2，P=0.0292）。在弯曲和伸展时，与对照组相比，SLE 伴 JA 患者的 ED 肌腱尺侧偏斜更常见，两名放射科医生均有统计学意义（P<0.0001）。
当 MCP 关节弯曲时，JA 与 SLE 患者 ED 肌腱的不稳定密切相关。
