Análise comparativa entre exame físico, ultrassonografia e ressonância magnética nos punhos e mãos no estudo das manifestações clínicas musculoesqueléticas da febre Chikungunya crônica

Abstract

Chikungunya fever (CF) is an arboviral disease transmitted by Aedes mosquitoes infected with the Chikungunya virus (VCHIK). It is an epidemic in several countries around the world. The disease causes chronic and disabling arthritis for up to five years after infection and affects many of the economically active population. Study one describes, through clinical, laboratory, ultrasound (US), and magnetic resonance (MRI) data, how a 49- year-old man developed psoriatic arthritis (PA) after CF infection. The clinical picture of classic synovitis and tenosynovitis secondary to CF, the persistence of inflammatory disease with signs of enthesitis and dactylitis on US and MRI, positive family history, and the appearance of skin lesions on the scalp strongly suggested post-CF PA, according to the criteria of the American College of Rheumatology. Study two aimed to analyze the musculoskeletal changes in the wrists and hands through physical examination (PE), US, and MRI. Thirty patients with a proven laboratory diagnosis of CF were evaluated in the chronic phase of the disease. There was a predominance of females, and the average age was 54.7 years. The analyzed sites were the interphalangeal (IF), metacarpophalangeal (MCF), and wrist/midcarpal joints. The interval between PE and imaging exams was seven days, and the interval between US and MRI was at most two days. The kappa coefficient was calculated to estimate the agreement between the PE, US, and MR findings. A significant agreement was observed between PE and US in diagnosing synovitis. The only statistically significant (moderate agreement) between US and MRI was the finding of flexor tenosynovitis. US has potential for diagnostic confirmation of suspected synovitis based on positivity of the PE. The limited agreement between US and MRI for other findings, in turn, may suggest a complementary role for these methods.