engleski

THERMAL POINT OF CARE DIAGNOSTIC TOOL FOR MEASUREMENT OF JOINT INFLAMMATION

Introduction: Since the dawn of the medicine, heat (lat. calor) is one of the four main signs of inflammation. Although it is recognized more than 2, 000 years ago, there is still no reliable, simple and objective method to measure the warmth of inflamed joint, which is therefore most often assessed only by clinical examination, with very low validity and reliability. Objectives: To investigate the use of smartphone attached mobile thermography for the assessment of joint inflammation. Methods: Twenty participants with various forms of arthritis and/or arthralgia participated in this pilot cross-sectional observational study. Average age of the participants was 10 years (2, 5 - 17, 5). In all of the participants Power Doppler vascularization signal of both knee joints was graded from 0-3 by EULAR certificated instructor in MSUS. FLIR ONE smartphone connected device was used to obtain infrared thermal image of every patient’s knee joint prior to the MSUS examination, without clothes and with same environment conditions (room temperature was set to 20°C). Acquired images were analyzed using FLIR Tools software for thermal image analysis with automatically set range of temperatures. On every image, both knee joints were selected using manual ellipse measurement tool and the data on average, minimum and maximum temperature inside the circle was collected. Subsequent statistical analysis of selected data was performed with Graphpad Prism software.  Results: In sixteen knee joints of nine patients a PD signal was above 0, 5 (0, 5-2, 5), which was defined as an active inflammation, while in twenty-four knee joints of thirteen patients PD signal was 0, which was defined as no inflammation. Average value of average temperature in knee joints with inflammation was 33, 72°C (31, 3°C - 35, 4°C) and in patients without inflammation 29, 81°C (23, 9°C - 31, 9°C), average value of maximal temperature was 34, 98°C (32, 7°C - 36, 9°C) and 31, 08°C (25°C - 33, 3°C), while average value of difference between maximal and minimal temperature was 4, 73°C (2, 6°C - 7, 7°C) and 2, 96°C (1, 2°C - 5, 7°C) respectively. Statistical analysis revealed significant difference in all of the measurements between knee joints with and without active inflammation (p<0, 05). Conclusion: In our proof of concept study we investigated the usefulness of thermography with FLIR ONE, a cheap, portable and easy to use compact device, in joint inflammation assessment. For objective evaluation, MSUS with Power Doppler scoring of synovial vascularization was used. This method is almost a gold standard in joint inflammation assessment and it effectively measures increased blood flow inside the joint, which is one of the main causes of higher temperature. Preliminary results of our study suggested FLIR ONE thermography can be used as a bedside screening tool for joint inflammation, with a potential in assessing and quantifying degree of inflammation. This is in consistence with the results of a recent study which indicated the described method has a sufficiently high validity and reliability to be recommended for assessment of subclinical inflammation in patients with pressure ulcer and diabetic foot (1). After confirmation in a larger cohort, our results could facilitate this innovative technique as a tool for joint inflammation assessment in everyday clinical practice. REFERENCES: 1. T. Kanazawa, G. Nakagami, T. Goto, et. al. Use of smartphone attached mobile termography assesing subclinical inflammation: a pilot study. J Wound Care. 2016. Apr ; 25(4)177-82.

termography; FLIR

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