Clinical And Imaging Features Of Bone And Joint Damage Caused By Brucellosis

Objective:To acknowledge the clinical characteristics of brucellosis combined osteoarthropathy,timely diagnosis and early intervention of brucellosis osteoarthritis,so as to significantly reduce the rate of disability,reduce the impact of the disease on the life of patients.Methods:In total of 188 cases of brucellosis were collected,including 110 cases without bone and joint injury and 78 cases of brucellosis osteoarthritis.The general situation,epidemiological contact history,clinical stages,symptoms,signs and laboratory examinations of the osteoarticular injury group were statistically analyzed.Retrospective analysis was performed after comparison with the group without joint injury.The modalities of imaging diagnosis were divided into MRI group and SPECT/CT group to explore the imaging features and diagnostic advantages of each modality.Results:In this study,in total of 188 cases of effective hospitalized patients with brucellosis were collected from 2016 to 2018,including 78 cases of brucellosis combined with osteoarthritis(41.5%),and 110 cases of brucellosis combined with osteoarthritis.1.The situation for the distribution of patients with brucellosis combined with osteoarthritis(1)Gender distribution:there were more males in the group of brucellosis combined with osteoarthritis,and the ratio of males to females was 2.25:1.(2)Age distribution:the average age was 46.87 years old and 12.18 years old.The number of patients’age between 41 and 65was the highest,the ratio reached up to 70.5%.(3)Ethnic distribution:in this study,the majority of the 59 cases in the group of brucellosis combined with osteoarthritis were the han nationality,accounting for 75.6%of the total number in this group.(4)Contact history:most of patients had a clear contact history with cattle and sheep before the onset of the disease,among which 71 cases were infected by direct contact,accounting for 91.0%of the total number of patients in this group.(5)There were 49 cases in chronic stage,accounting for62.8%,and 29 cases in acute stage,accounting for 37.2%.(6)the main clinical features of patients in the group of brucellosis complicated with osteoarthritis included fever(45 cases,57.7%),fatigue(66 cases,84.6%),hyperhidrosis(53 cases,67.9%),joint muscle pain(75cases,96.2%),and joint tenderness(69 cases,88.5%).(7)laboratory examination:ALT,AST and CRP increased,and SAT1:100++or above accounted for 84.6%.(8)joint invasion:lumbar spine(37 cases,47.4%),sacroiliac joint(47 cases,60.3%),knee joint(30 cases,38.5%)were common.2.Comparison of the group of bone and joint injury complicated with bubonic disease and the group of no joint and joint injury complicated with bubonic diseaseThe age of the osteoarthritis group was greater than that of the group without bone and joint damage,and the difference was statistically significant(t=-2.65,P<0.05).Chronic stage accounted for a large proportion in the brucellosis complicated with bone and joint damage group,and the difference between the two groups was statistically significant(?~2=6.725,P=0.01).There were statistically significant differences between the brucellosis group with bone and joint damage and the brucellosis group without joint damage,such as muscle and joint pain,limited mobility,joint tenderness,joint swelling,low fever and low CRP.3.Imaging examinationIn this study,36 patients with brucellosis complicated with osteoarthropathy underwent SPECT examination,and 20 of them underwent MRI examination at the same time at the symptomatic site.Results:(1)SPECT detected lesions that MRI failed to detect,suggesting that SPECT may have an advantage in early detection.(2)SPECT detection of asymptomatic lesions,such as sternoclavicular joints,shoulder joints,and elbow joints,indicated that SPECT examination of the brucellosis site was more comprehensive.(3)Patients was found to have lumbar spine involvement after two examination methods,but MRI for bone marrow edema and paravertebral abscess has been clearly shown,indicating that MRI for local lesions of soft tissue imaging than SPECT has advantages.Conclusion:In Hulunbuir region,brucellosis combined with osteoarthritis is a common complication of brucellosis,and male patients are more than female,the middle-aged and the elderly are the majority and most of them have a history of direct contact with sick animals.The main clinical symptoms are fever,fatigue,hyperhidrosis and joint pain.Clinical signs are mainly joint tenderness,with more serious status may cause limitation on the movement.The main invasion of the lumbar spine,sacroiliac joint,knee joint.Patients with brucellosis at advanced age and a chronic course are at high risk for osteoarthritis.Compared with MRI,SPECT examination in patients with brucellosis complicated with osteoarthritis could detect the lesion earlier and areas where symptoms are not obvious can also be found.