BackgroundRheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by synovial inflammation, potential cartilage and bone damages. Evaluation with ultrasound (US) has come into prominence due to conventional radiography is relatively insensitive on soft tissue inflammatory changes and early bone erosions (1,2).ObjectivesThe value of US has been shown in early arthritis, but is not well known for established RA. The aim of this study is to determine the relation between US signal, disease activity, articular damage and disability in established RA patients.MethodsForty-four RA patients (21 women, 23 men) were enrolled to the study. Age and gender, duration of disease, morning stiffness, disease activity score 28 (DAS28), The Rheumatoid Arthritis Articular Damage (RAAD) score, Hand disability Index (HDI), DASH (Disabilities of the Arm, Shoulder and Hand) scale, and grip strength values were recorded. Wrist, I-II- III. metacarpophalangeal and proximal interphalangeal joints of dominant hand were examined by both B mode US (BMOD) and Power Doppler US (PDUS).ResultsAll of the 44 patients were established RA. The median of disease duration was 156 (48–420) months. DAS 28 score was 2.86 (0.68–5.70) and 54.5% of the patients were in remission. BMOD synovitis, erosion and PDUS synovitis total scores were 20 (6–36); 6 (0–17); 1 (0–14) respectively. Although US findings were not correlated with DAS 28 and grip strength; there was poor correlation between US findings and DASH, RAAD and disease duration (Table 1). Signs of synovitis indicated with PDUS in 63.3% of the joints assessed. High-grade PDUS signal (grade 3) was found in 10 (22.7%) of the patients. Duration of morning stiffness, HDI and DASH scores were worse in the patients with high-grade PDUS signals (p=0.01, 0.04, 0.01 respectively)Table 1.Correlation coefficients between clinical, ultrasound and functional variablesBMOD synovitisBMOD erosionsPDUS synovitis
TotalTotalTotal
rprprP
DASH0.370.02*0.190.200.130.38HDI0.210.170.170.280.210.17RAAD0.330.02*0.410.00*0.220.15DAS 28-0.040.780.010.95-0.050.75MS0.240.12-0.100.510.200.19Disease duration0.130.380.460.00*-0.310.03*Lateral GS0.070.64-0.060.69-0.060.70Tip GS0.110.49-0.270.080.090.56Three fingered GS0.210.89-0.170.270.050.76Mass grasp-0.080.59-0.0780.61-0.120.43BMOD: B mode ultrasound, PDUS: Power Doppler ultrasound, DASH: Disabilities of the Arm, Shoulder and Hand, HDI: Hand disability index, RAAD: Rheumatoid Arthritis Articular Damage, DAS 28: Disease activity score, MS: Morning stiffness, GS: Grip strength. *P<0.05.ConclusionsUS scores in established RA patients are usually high because of synovial hypertrophy. It is considered that the high grade PDUS signals are more appropriate for evaluation of long-standing RA patients. Furthermore in this study, grade 3 PDUS signals were found to be a good indicator of synovial inflammation, morning stiffness, and disability.References
Concordance between Clinical and ultrasound findings in rheumatoid arthritis. Garrigues F, Jousse-Joulin S, Bout...
