Monoartritlerin değerlendirilmesi, bir yıllık, retrospektif tek merkez deneyimi

Year 2021, Volume: 54 Issue: 3, 399 - 404, 01.01.2022

Müçteba Enes Yayla

https://doi.org/10.20492/aeahtd.974893

Abstract

Amaç: Mevcut çalışmada 3. Basamak bir sağlık kuruluşuna monoartrit kliniği ile başvurmuş hastaların genel özelliklerini, değerlendirmeler sonucu almış oldukları tanıları, hangi hastaların kronikleştiğini ve oligoartrit ya da poliartrit kliniğine ilerlemiş olduğunu ortaya koymayı amaçladık.
Gereç ve Yöntem: Ekim 2019 – Ekim 2020 tarihleri arasında 18 yaşından büyük ve bilinen romatolojik bir hastalığı olmayan ilk kez monoartrit kliniğine sahip olmuş 92 hasta retrospektif olarak incelendi. Tüm hastaların özellikleri, değerlendirmeler sonucu almış oldukları tanıları kaydedildi. Kronik artritli hastalar ile kendini sınırlayan artritli olan hastaların özellikleri karşılaştırıldı.
Bulgular: Hastaların %66,3’ ü erkekti. En fazla etkilenen eklemler diz (%38), 1.metatarsofalangeal (MTF) eklem (%31,5) ve ayak bileği eklemleriydi (%20,7). Hastaların %60,9’ unda klinik, tedavi ile ya da spontan olarak kendini sınırlamıştı, %39,1 hastada kronik artrit ortaya çıktı. Kronik artrit gelişen hastaların 7’ sinde monoartrit tablosu oligoartrit ya da poliartrit tablosuna dönmüştü. Hastaların klinik değerlendirme süreci sonunda almış olduğu tanılara bakıldığında gut %37, periferik SPA %15,2, RA %9,8 ve Behçet %4,3 hastada saptandı. Diğer tanılar ise septik artrit, post-streptokoksik artrit, undiferansiye bağ dokusu hastalığı, sjögren hastalığı, malignite ilişkili artrit, travmaya sekonder artrit ve osteoartritti. %19 Hastada ise sınıflandırılamayan artrit tablosu tespit edildi Erkek cinsiyet (p=0.028) ve hiperürisemi (p<0.001) kendini sınırlayan artritlerde daha sıkken, RF (p=0.005) ve CCP (p=0.006) pozitifliği, progresif artrit sıklığı kronikleşen artritlerde daha sıktı.
Sonuç: 3. Basamak bir sağlık kuruluşuna çeşitli monoartrit nedenleri ile hastalar sıklıkla başvurabilmektedir. Hastaların doğru tanı ve tedaviyi zamanında alması olası morbiditeyi önlemek açısından önemlidir.

Keywords

monoartrit, gut, kendini sınırlayan artrit, kronik artrit

Supporting Institution

Yok

Evaluation of monoarthritis, one-year, retrospective single-center experience

Abstract

Aim: In the current study, we aimed to reveal the general characteristics of the patients who applied to a tertiary health institution with a monoarthritis clinic, the diagnoses they received as a result of the evaluations, which patients became chronic, and progressed to the clinic of oligoarthritis or polyarthritis.
Material and Method: Between October 2019 and October 2020, 92 patients who were older than 18 years of age and had no known rheumatologic disease and had a monoarthritis clinic for the first time were analyzed retrospectively. The characteristics of all patients and the diagnoses they received as a result of the evaluations were recorded. The features of patients with chronic arthritis and patients with self-limiting arthritis were compared.
Results: 66.3% of the patients were male. The most affected joints were knee (38%), first metatarsophalangeal (MTF) joint (31.5%) and ankle (20.7%). In 60.9% of the patients, the clinic was self-limited with treatment or spontaneously, and chronic arthritis developed in 39.1% of the patients. In 7 of the patients who developed chronic arthritis, the monoarthritis table turned into oligoarthritis or polyarthritis. Considering the diagnoses of the patients at the end of the clinical evaluation process, gout was found in 37%, peripheral SPA in 15.2%, RA in 9.8% and Behçet's syndrome in 4.3%. Other diagnoses were septic arthritis, post-streptococcal arthritis, undifferentiated connective tissue disease, Sjogren's disease, malignancy-associated arthritis, arthritis secondary to trauma, and osteoarthritis. Unclassifiable arthritis was detected in 19% of the patients. While male gender (p=0.028) and hyperuricemia (p<0.001) were more common in self-limiting arthritis, RF (p=0.005) and CCP (p=0.006) positivity and progressive arthritis were more common in chronic arthritis.
Conclusion: Patients could frequently apply to a tertiary health institution with various causes of monoarthritis. It is important for the patients to receive the correct diagnosis and treatment in a timely manner in order to prevent possible morbidity.

References

• 1. Becker JA, Daily JP, Pohlgeers K. Acute monoarthritis: diagnosis in adults. Am Fam Physician. 2016;94:810-6.
• 2. Jeong H, Kim AY, Yoon HJ, et al. Clinical courses and predictors of outcomes in patients with monoarthritis: a retrospective study of 171 cases. Int J Rheum Dis. 2014;17:502-10.
• 3. Melikoğlu MA. Monoartrite Yaklaşım. Romatizma/Rheumatism. 2007;22:137-43.
• 4. Inaoui R, Bertin P, Preux P-M, et al. Outcome of patients with undifferentiated chronic monoarthritis: retrospective study of 46 cases. Joint Bone Spine. 2004;71:209-13.
• 5. Binard A, Alassane S, Devauchelle-Pensec V, et al. Outcome of early monoarthritis: a followup study. J Rheumatol. 2007;34:2351-7.
• 6. Hülsemann J, Zeidler H. Undifferentiated arthritis in an early synovitis out-patient clinic. Clin Exp Rheumatol. 1995;13:37-43.
• 7. Chisari E, Yaghmour KM, Peat F, et al. Patients Presenting with a Hot, Swollen Joint: A Single-Centre Retrospective Analysis. Current rheumatology reviews. 2020;16:38-42.
• 8. Kaarela K, Tiitinen S, Luukkainen R. Long-term prognosis of monoarthritis: a follow-up study. Scand J Rheumatol. 1983;12:374-6.
• 9. Blocka KL, Sibley JT. Undiagnosed chronic monarthritis. Clinical and evolutionary profile. Arthritis Rheumatol. 1987;30:1357-61.
• 10. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569-81.
• 11. Weichsler B, Davatchi F, Lehner T, et al. Criteria for diagnosis of Behçet's disease. Lancet (British edition). 1990;335:1078-80.
• 12. Neogi T, Jansen TLTA, Dalbeth N, et al. 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015;67:2557-68.
• 13. Zeidler H, Amor B. The Assessment in Spondyloarthritis International Society (ASAS) classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general: the spondyloarthritis concept in progress. Ann Rheum Dis. 2011;70:1-3.
• 14. Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheumatol. 2006;54:2665-73.
• 15. Selmi C, Gershwin ME. Diagnosis and classification of reactive arthritis. Autoimmun Rev. 2014;13:546-9.
• 16. Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: a consensus and data‐driven methodology involving three international patient cohorts. Arthritis Rheumatol. 2017;69:35-45.
• 17. Lequesne M, Jaffres R, Cassan P, et al. The course of monoarthritis of unknown origin. Study of 47 cases followed-up for more than 3 years. Rev Rhum Mal Osteoartic. 1972;39:749-55.
• 18. Devlin J, Gough A, Huissoon A, et al. The outcome of knee synovitis in early arthritis provides guidelines for management. Clin Rheumatol. 2000;19:82-5.
• 19. Norli ES, Brinkmann GH, Kvien TK, et al. Joint Distribution and Two‐Year Outcome in 347 Patients With Monoarthritis of Less Than Sixteen Weeks’ Duration. Arthritis Care Res. 2020;72:705-10.
• 20. Laura McGregor MF. In: Gary S. Firestein SEG, Iain B. McInnes, James R. O’Dell., editor. Kelley and Firestein’s textbook of rheumatology. Acute Monoarthritis. Tenth Edition ed. Philadelphia, PA: Elsevier; 2017. p.605-14.
• 21. McGregor L. FM. Kelley and Firestein’s textbook of rheumatology. Tenth edition ed, Philadelphia, PA: Elsevier; 2017 . 22. de Rooy DP, van der Linden MP, Knevel R, et al. Predicting arthritis outcomes—what can be learned from the Leiden Early Arthritis Clinic? Rheumatology (Oxford). 2011;50:93-100.