Detection of subclinical synovial hypertrophy by musculoskeletal gray‐scale/ power Doppler ultrasonography in systemic lupus erythematosus patients: A cross‐sectional study

Abstract

Objective: Laboratory investigations are invasive methods. Magnetic resonance imaging (MRI) has a small field of view. Ultrasound can be performed at multiple parts of the body. The objective of the study was to find out subclinical synovial hypertrophy in systemic lupus erythematosus patients using gray-scale/power Doppler ultrasonography. Methods: A total of 247 systemic lupus erythematosus (without musculoskeletal involvement) patients from 21 February 2017 to 28 October 2018 were included in the cross-sectional study. Patients were subjected to physical examinations, laboratory tests, and gray-scale/power Doppler ultrasonography examinations. Synovial hypertrophy was confirmed if it was present in at least 4 out of 100 of the examined location sites. MRI examinations were performed for confirmation purposes. Spearman correlation was performed between imaging and laboratory investigations at the 99% confidence level. Results: No correlation was observed for results of synovial hypertrophy between physical examinations/laboratory tests and gray-scale/power Doppler ultrasonography examinations except erythrocyte sedimentation rate (r = 0.354). Cost of laboratory tests (315.47 ± 19.15 ¥/person) for subclinical synovial hypertrophy detection was higher than that of gray-scale/power Doppler ultrasonography examinations (135.47 ± 8.17 ¥/person, P <0.0001, q = 230.87). Results of gray-scale/power Doppler ultrasonography have a correlation with results of MRI (r = 0.34). Conclusion: Only perform gray-scale/power Doppler ultrasonography examinations for regular maintenance of rheumatologic disease in systemic lupus erythematosus patients. K E Y W O R D S bursitis, erythrocyte sedimentation rate, subclinical synovitis, systemic lupus erythematosus, ultrasonography | 1059 HAN ANd TIAN

Subclinical synovitis impact on the progression of lupus joint disease: A 10-year longitudinal multicenter study

“…In both groups, he did not find a satisfactory association between the clinical activity indices and the existence of SS. Han et al 2 published the largest series of patients with SLE without musculoskeletal symptoms. Of his cohort of 247 patients, 41 had at least 4 joints with synovitis, but he was unable to demonstrate any association with the clinical or analytical characteristics of the disease except for a weak correlation ( r = 0.354) with the erythrocyte sedimentation rate.…”

“…The existence of synovitis in patients with systemic lupus erythematosus (SLE) has been demonstrated in different 1 Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain 2 Faculty of Biomedical Sciences and Health, European University of Madrid, Villaviciosa de Odón, Madrid, Spain 3 Rheumatology Unit, HLA Moncloa University Hospital, Madrid, Spain 4 Family and Community Medicine, Urgency & Emergency Department, Ramón y Cajal University Hospital, Madrid, Spain studies. [1][2][3][4][5][6] Subclinical synovitis (SS) is defined as an inflammatory finding identified in the synovial territory of patients without joint symptoms. 1,[5][6][7] Different authors have documented SS in large ultrasound studies (US) that include the entire spectrum of patients with joint manifestations, not only the asymptomatic ones.…”

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

“…In connective tissue diseases such as systemic lupus erythematosus (SLE) 79 80 , primary Sjögren’s syndrome (pSS) 81 , and mixed connective tissue disease (MCTD) 82 , US reveals subclinical synovitis located especially on the MCPs and wrist in patients without joint symptoms and correlates with clinical disease activity indices 83 84 . Tenosynovitis is the most common finding in systemic sclerosis 85 and, similarly to SLE, mostly affects the wrist and MCP joints 86 .…”