ORIGINAL PAPER
The initial ultrasonographic examination of hands and feet joints in patients with early rheumatoid arthritis
Submission date: 2015-06-15
Final revision date: 2015-08-25
Acceptance date: 2015-08-28
Online publication date: 2015-09-21
Publication date: 2015-09-15
Reumatologia 2015;53(4):179-185
KEYWORDS
TOPICS
ABSTRACT
Objectives: The aim was to assess of the morphology, intensity, and activity of changes in the first ultrasonographic (US) examination of hands and feet in patients with early arthritis (lasting up to 12 months) who were ultimately diagnosed with rheumatoid arthritis (RA). An attempt was made to demonstrate a correlation between the intensity of lesions in US and selected laboratory parameters.
Material and methods: Ultrasonographic examination was performed using a LOGIC GE 500 device on a group of 60 patients with arthritis (46 women, 14 men) aged 18–80, previously untreated. In total, 3120 hand and feet joints were examined. The assessment focused on the presence of joint effusion, synovial proliferation and power Doppler signals (assessed on a semi-quantitative scale). Each patient underwent laboratory tests, necessary for making a diagnosis. In order to analyze the correlations between changes in US and laboratory parameters, erythrocyte sedimentation rate (ESR), reactive protein test (CRP), rheumatoid factor (RF), and anti-citrullinated protein antibodies (ACPAs) were used.
Results: In the study group, the average duration of arthritis symptoms until the first US examination was 5.6 months. Among the 3120 examined hand and foot joints, deviations from the norm appeared in 1093 joints, synovial hypertrophy was found in 471 joints (grade 1 synovial hypertrophy was reported most frequently), while presence of signal in Power Doppler was revealed in 261 joints (grade 1 was observed most frequently). A statistically significant correlation was found between the intensity of changes in Power Doppler and CRP concentration.
Conclusions: In patients with increased concentrations of CRP, we may expect arthritis of higher intensity, therefore, in order to prevent the progression of destructive changes, it is necessary to quickly implement effective disease-modifying antirheumatic treatment. The conducted research showed that the activity of joint inflammation is not affected by the values of ESR and the presence of RF or ACPAs.
Material and methods: Ultrasonographic examination was performed using a LOGIC GE 500 device on a group of 60 patients with arthritis (46 women, 14 men) aged 18–80, previously untreated. In total, 3120 hand and feet joints were examined. The assessment focused on the presence of joint effusion, synovial proliferation and power Doppler signals (assessed on a semi-quantitative scale). Each patient underwent laboratory tests, necessary for making a diagnosis. In order to analyze the correlations between changes in US and laboratory parameters, erythrocyte sedimentation rate (ESR), reactive protein test (CRP), rheumatoid factor (RF), and anti-citrullinated protein antibodies (ACPAs) were used.
Results: In the study group, the average duration of arthritis symptoms until the first US examination was 5.6 months. Among the 3120 examined hand and foot joints, deviations from the norm appeared in 1093 joints, synovial hypertrophy was found in 471 joints (grade 1 synovial hypertrophy was reported most frequently), while presence of signal in Power Doppler was revealed in 261 joints (grade 1 was observed most frequently). A statistically significant correlation was found between the intensity of changes in Power Doppler and CRP concentration.
Conclusions: In patients with increased concentrations of CRP, we may expect arthritis of higher intensity, therefore, in order to prevent the progression of destructive changes, it is necessary to quickly implement effective disease-modifying antirheumatic treatment. The conducted research showed that the activity of joint inflammation is not affected by the values of ESR and the presence of RF or ACPAs.
REFERENCES (31)
1.
Sudoł-Szopińska I, Zaniewicz-Kaniewska K, Warczyńska A, et al. The pathogenesis of rheumatoid arthritis in radiological studies. Part II: Imaging studies in rheumatoid arthritis. J Ultrason 2012; 12: 319-328.
2.
Sudoł-Szopińska I, Kontny E, Maśliński W, et al. The pathogenesis of rheumatoid arthritis in radiological studies. Part I: Formation of inflammatory infiltrates within the synovial membrane. J Ultrason 2012; 12: 202-213.
3.
Zaniewicz-Kaniewska K, Sudoł-Szopińska I. Usefulness of sonography in the diagnosis of rheumatoid hand. J Ultrason 2013; 13: 329-336.
4.
Korkosz M, Wojciechowski W, Kapuścińska K, et al. Niskopolowy rezonans magnetyczny i ultrasonografia wysokiej rozdzielczości nadgarstka, stawów śródręczno-paliczkowych i międzypaliczkowych bliższych rąk oraz przeciwciała antycytrulinowe i czynniki reumatoidalne w rozpoznawaniu wczesnego zapalenia stawów u pacjentów z niezróżnicowanym zapaleniem wielostawowym. Reumatologia 2009; 47: 51-59.
5.
Mitchell KL, Pisetsky DS. Early rheumatoid arthritis. Curr Opin Rheumatol 2007; 19: 278-283.
6.
Jeka S. Przegląd nowoczesnych technik ultrasonograficznych w reumatologii – ultrasonografia błony maziowej. Acta Bio-Optica et Informatica Medica. Inżynieria Biomedyczna 2010; 16: 237-420.
7.
Kawashiri S, Suzuki T, Okada A, et al. Musculoskeletal ultrasonography assists the diagnostic performance of the 2010 classification criteria for rheumatoid arthritis. Mod Rheumatol 2013; 23: 36-43.
8.
Østergaard M, Pedersen SJ, Døhn UM. Imaging in rheumatoid arthritis – status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol 2008; 22: 1019-1044.
9.
Naredo E, Collado P, Cruz A, et al. Longitudinal power doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. Arthritis Rheum 2007; 57: 116-124.
10.
Żuber Z, Rutkowska-Sak L, Słowinska I, et al. Przydatność badania ultrasonograficznego w diagnostyce różnicowej zmian zapalnych w stawach kolanowych. Reumatologia 2007; 45: 173-176.
11.
Jeka S, Murawska A. Ultrasonografia błony maziowej w chorobach reumatycznych. Reumatologia 2009; 47: 339-343.
12.
Wakefield RJ, Gibbon WW, Conaghan PG, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000; 43: 2762-2770.
13.
Scheel AK, Hermann KA, Ohrndorf S, et al. Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis 2006; 65: 595-600.
14.
Szkudlarek M, Court-Payen M, Jacobsen S, et al. Inter observer agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003; 48: 955-962.
15.
Zayat A, Ellegard K, Conaghan P, et al. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis 2014; 74: 897-903.
16.
Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32: 2485-2487.
17.
Alcalde M, D’Agostino MA, Bruyn GAW, et al. A systematic literature review of us definitions, scoring systems and validity according to the omeract filter for tendon lesion in RA and other inflammatory joint diseases. Rheumatology (Oxford) 2012; 51: 1246-1260.
18.
Ohrndorf S, Backhaus M. Advances in sonographic scoring of rheumatoid arthritis. Ann Rheum Dis 2013; 72 Suppl 2: ii69-75.
19.
Xiao H, Liu M, Tan L, et al. Value of ultrasonography for diagnosis of synovitis associated with rheumatoid arthritis. Int J Rheum Dis 2014; 17: 767-775.
20.
Witt M, Mueller F, Nigg A, et al. Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis. Arthritis Rheum 2013; 65: 1694-1701.
21.
Scirè CA, Montecucco C, Codullo V, et al. Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology (Oxford) 2009; 48: 1092-1097.
22.
Brown AK, Conaghan PG, Karim Z, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008; 58: 2958-2967.
23.
Foltz V, Gandjbakhch F, Etchepare F, et al. Power doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity. Arthritis Rheum 2012; 64: 67-76.
24.
Kawashiri S, Suzuki T, Nakashima Y, et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power doppler subclinical synovitis is associated with bone erosion. Rheumatology (Oxford) 2013; 53: 562-569.
25.
Botar-Jid C, Bolboaca S, Fodor D, et al. Gray scale and power doppler ultrasonography in evaluation of early rheumatoid arthritis. Med Ultrason 2010; 12: 300-305.
26.
Naredo E, Gamero F, Bonilla G, et al. Ultrasonographic assessment of inflammatory activity in rheumatoid arthritis: comparison of extended versus reduced joint evaluation. Clin Exp Rheumatol 2005; 23: 881-884.
27.
Navalho M, Resende C, Rodrigues AM, et al. Bilateral MR imaging of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis. Radiology 2012; 264: 823-833.
28.
Bruyn GAW, Möller I, Garrido J, et al. Reliability testing of tendon disease using two different scanning methods in patients with rheumatoid arthritis. Rheumatology (Oxford) 2012; 51: 1655-1661.
29.
Szkudlarek M, Wakefield RJ, Backhaus M, et al. The discriminatory capacity of ultrasound in rheumatoid arthritis: active vs inactive, early vs advanced, and more. Rheumatology (Oxford) 2012; 51 Suppl 7: vii6-9.
30.
Sudoł-Szopińska I, Kontny E, Maśliński W, et al. Significance of bone marrow edema in pathogenesis of rheumatoid arthritis. Polish J Radiol 2013; 78: 57-63.
31.
Tamas M, Filippucci E, Becciolini A, et al. Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease. Rheumatology (Oxford) 2014; 53: 1100-1107.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Share
RELATED ARTICLE
| eISSN: | 2084-9834 |
| ISSN: | 0034-6233 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
