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SAT0564 Articular Involvement in Behçet Disease: An Ultrasonographic Study
  1. V. Picerno,
  2. G. Filippou,
  3. L. Cantarini,
  4. A. Adinolfi,
  5. V. Di Sabatino,
  6. I. Bertoldi,
  7. C. Toscano,
  8. M. Galeazzi,
  9. B. Frediani
  1. Rheumatology Unit, University of Siena, Departement of Clinical Sciences, Surgery and Neurosciences, Rheumatology Unit, Siena, Italy

Abstract

Background An articular involvement is reported in Behçet disease up to 70% of patients, varying from referred arthralgia to arthrtitis, generally non-erosive, poly- or oligoarticular. Some authors compared this joint involvement to Seronegative Spondyloarthritis, reporting prevalent involvement of entheses and sacroiliitis. Few US studies has been conducted in Behçet, focusing on tendon and enthesal evaluation

Objectives To evaluate the presence of US pathological findings of joints, tendons and entheses of patients affected by Behçet disease

Methods We enrolled consecutive patients with Behçet disease reaching the Rheumatologic Unit of our hospital between Feb 2014 and Jan 2016, irrespective of disease activity status and therapy. US exams was performed by a single operator with 8–18 MHz linear transducers (Esaote MyLab70). 42 joints (shoulders, elbows, wrists, MCPs, PIPs, hips, knees, ankles, MTPs), 12 entheses (triceps tendons,common extensor tendons, knee entheses, Achilles tendons) and 20 tendon sheats (flexor digitorum tendons, wrist's flexor and extensor tendons, anterior and posterior tibialis and peroneal tendons) were evaluated for each patient, using a stardardized technique. Grey scale (GS) and power Doppler (PD) US exam was performed to detect joint effusion, synovial hypertrophy and PD, classified with dicotomic and semiquantitative score (grade 0–3); effusion and synovial hypertrophy were combined in a single score and defined as synovitis. The presence/absence of tenosynovitis was evaluated for each site. At the entheseal level, we evaluated the presence of GS abnormalities of tendon structure (hypoechogenicity/thickness), enthesophytes and Doppler signal within the tendon or at the entheseal site, all classified as present/absent

Results We evaluated a total amount of 1596 joints, 760 tendons and 456 entheses from 38 patients (20 women). A grade 1 synovitis was observed in 158 joints (9,9%): 87 MTPs, 21 knees, 19 MCPs, 14 wrists, 11 ankles, 4 PIPs and 2 elbows; in 72 patients the finding was monolateral while in 43 patients it was observed bilaterally, notably at I and II MTPs and knees joints. A grade 2 synovitis was observed in 18 joints (1,12%): 16 MTPs, 1 knee and 1 MCP; no grade 3 synovitis was observed. A grade 1 PD was detected in 2 wrists, 2 MCPs and 7 MTPs joints and a grade 3 PD was observed in a single MCP joint. We observed the presence of tenosynovitis in 36 cases, all involving hand or wrist tendon structures. 12 entheses presented altered fibrillar pattern with hypoecogenicity (8 common extensor tendons and 4 knee entheses), while the presence of enthesophytes was observed at the common extensor in 4 cases, at triceps in 8, at quadriceps in 6, at proximal patellar insertion in 2, at Achilles tendon in 21; the presence of at least 1 grey scale abnormality was observed in 63 entheseal sites (13,81%). An intratendineous PD signal was observed in 27 cases (5,9%): 16 common extensor tendons, 4 quadriceps, 3 proximal patellar insertion, 4 Achilles tendons

Conclusions In a population of patients with Behçet disease we observed the presence of joint effusion in 11% and PD signal in 0,7% of examined joints, notably involving hands and feet joints. GS alteration of tendon structure was detected in 13,81% and an intratendineous PD signal in 5,9% of entheseal sites.A mild tenosynovitis was observed in 4,7% of examined tendons

Disclosure of Interest None declared

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