Dynamic thermography of the knee joints in rheumatoid arthritis (RA) in the course of the first therapy of the patient with methylprednisolone.
Thermography in rheumatology is most often used in a static manner: after having fulfilled the conditions of standardized preparation of the patient in a cold examination room one or more thermograms are taken in standard positions for the respective joints. In our hospital the thermograms are more or less supplementary. The main examination result is a rewarming curve of the skin over the knee joints. The rewarming is provoked by dry cooling of the skin for one minute. Calculation of the slope of the rewarming curve and plotting the slope on a logarithmic scale shows two different rewarming processes in the skin overlying inflamed joints. The faster one is the rewarming by the arterial blood flow in the skin and the slower one is an additional rewarming by a pathological venous skin blood flow originating from deeper tissues under the skin. One has to suppose that the occurrence of excessive nitric oxide production in inflamed tissues is responsible for this pathological venous skin blood flow. Until now only nine patients receiving for the first time methylprednisolone could be included in a therapy study. Therefore only slight indications can be seen in the results. Whereas the erythrocyte sedimentation rate (ESR [mm/h] becomes more homogeneous (lower confidence interval CI 95) over the course of the treatment with decreasing drug dose, the thermal signs of inflammatory activity as measured by dynamic thermography have greater CI 95 values at the end than at the beginning of the treatment under study. This indicates that not all patients had sufficient antiinflammatory medication with the final 6 mg/d of methylprednisolone as measured by dynamic thermography but not by ESR or CRP.
Rusch
D
D
Kerckhoff Clinic and Foundation Bad Nauheim, Department of Rheumatology, Ludwigstrasse 37-39, D-61231 Bad Nauheim, Germany.
Follmann
M
M
Boss
B
B
Neeck
G
G
D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001799:Blood Sedimentation; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007719:Knee Joint / Q000187:drug effects*; D008775:Methylprednisolone / Q000008:administration & dosage*; D012881:Skin Temperature / Q000187:drug effects; D013817:Thermography; D016896:Treatment Outcome
D008775:Methylprednisolone