Radiological methods in rheumatoid arthritis and osteoarthritis
Sammanfattning: The dissertation's theme is the critical role of radiology when evaluating two different groups of patients. Firstly, patients with rheumatoid arthritis (RA) of the cervical spine were studied to evaluate upper spine instability with dynamic computed tomography (CT). Secondly, after anterior cruciate ligament (ACL) reconstruction, patients with a long-term follow-up were studied to evaluate osteoarthritis (OA). In paper I, 21 consecutive patients with atlantoaxial subluxation due to RA planned for atlantoaxial fusion were included. Radiographs were obtained in neutral and flexed positions, CT and Magnetic Resonance Imaging (MRI) was performed with the neck in the neutral position and CT also in flexion. Radiographs and CT measurements of atlantoaxial subluxation correlated but were larger using radiographs than CT in flexion. The spinal cord compression was significantly worse at CT obtained in flexed position than MRI in the neutral position. In papers II and III, the cohort consisted of 60 patients, and in paper IV, 73 patients. Mean follow-up was 31 years after ACL reconstruction. MRI, radiographs, International Knee Documentation Committee (IKDC) clinical assessment, Knee injury Osteoarthritis Outcome Score (KOOS), Short Form-36 (SF-36), Tegner Activity Scale, and KT-1000 arthrometer were used in order to evaluate the patients. Thirty-three patients showed an intact ACL graft, and 40 a ruptured ACL graft. Forty-nine patients had tibiofemoral OA, and 28 patients had patellofemoral OA. Patients with ruptured ACL grafts had more OA in the medial tibiofemoral compartment than those with an intact ACL graft. Sport and Recreation Function and Quality of life scores were higher in patients with an intact ACL graft than those with a ruptured ACL graft. All subscales of KOOS were higher in the group without OA. KOOS Quality of life score was lower than for a control group of men. The IKDC overall clinical assessment was worse in patients with a ruptured ACL graft. This thesis suggests that radiographs remain the primary imaging method for evaluating atlantoaxial instability. However, CT in flexed position is useful in the preoperative imaging workup. Patients with a ruptured ACL graft presented with more OA of the medial tibiofemoral compartment than those with an intact graft. Patients with an intact ACL graft and those without OA reported higher sports activity and recreation and better knee-related Quality of life. Knee-related Quality of life in the study group was reduced compared to a reference group.
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