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High-resolution ultrasound for the study of target joints in rheumatoid arthritis To the Editor: Conventional radiography remains the "gold standard" for the evaluation of joint damage and its progression in rheumatoid arthritis (RA), but changes may not be evident radiographically until late in the disease course (1). Magnetic resonance imaging (MRI) has been used to study patients with early RA, but high cost and lack of standardization limit its use (2). Several studies have now shown that high-resolution ultrasound (US) of the metacarpophalangeal (MCP) joints can be very informative in the evaluation of RA of various durations (3-5). Erosions have been visualized in selected hand joints (second MCP) and foot joints (fifth metatarsophalageal [MTP]) (5). In fact, detection of more erosions per joint and per patient with US as compared with radiography was demonstrated by Wakefield et al in a recent study reported in Arthritis & Rheumatism (3). The present pilot study was undertaken to assess the feasibility of performing US in selected (target) joints of patients with RA, and to determine if this technique offers additional information beyond that obtained with conventional radiography. MRI was chosen as a comparator method because of its high sensitivity. Our Institutional Review Board approved this study. Ten unselected patients with RA according to the criteria of the American College of Rheumatology (formerly, the American Rheumatism Association) (6) and 5 healthy volunteers who, as a group, were of comparable age (mean 45 years), sex (80% women), and ethnicity (80% white) with the patients were studied. The duration of RA was Ͻ2 years in 2 patients, 3-5 years in 5, and Ͼ5 years in 3. Six of the 10 patients were positive for IgM rheumatoid factor. Five of the 10 were receiving a disease-modifying antirheumatic drug (methotrexate in 4 of the 5); 3 other patients were receiving anti-tumor necrosis factor therapy. Joints selected for US imaging included the second and fifth MCP joints and the fifth MTP joints. These joints were selected on the basis of their likelihood of early involvement in RA as well as their easy accessibility with the US probe. The first MTP joints, not considered targets for involvement early in the course of RA, were also examined because of their easy accessibility with the US probe. Conventional radiographs of the hands/wrists and feet were obtained. These included 3 views (anteroposterior, lateral, and oblique) obtained using standard techniques (Kilovolt peak 54, milliampere-second 2.5, fine detail film-screen combination). Coronal T1-weighted MR images of the hands and feet were obtained using a 1.5T body scanner (Signa; GE, Milwaukee, WI), dedicated extremity coils, and the following parameters: repetition time 500 msec, echo time 15 msec, 256 ϫ 192 matrix, 3 mm thickness with 0.5 mm gap, field of view 20 cm). Finally, US of the joints as noted above was performed by one of us (RL-B), using 10-15 MHz highresolution linear array transducers with small footprints. Indi-2. Molenaar T...

sCD40L plays a biologically active role, with decreased levels at flare at low SLEDAI scores. At high SLEDAI scores there are mechanisms that involve platelets and that are inhibited by high doses of prednisone that lead to increased serum values of sCD40L at flare.