Hand Arthritis in Systemic Lupus Erythematosus: An Ultrasound Pictorial Essay

Abstract

A small minority of systemic lupus erythematosus (SLE) patients may develop a deforming arthritis, typically with a non-erosive (Jaccoud's) pattern, although erosive features indistinguishable from rheumatoid arthritis may also occur. High-resolution ultrasonography (HRUS) allows detailed 'real time' imaging of joint and tendon morphostructural changes involving the hand in patients with several rheumatic diseases. The main aim of this pictorial essay is to provide the first descriptive HRUS and power Doppler (PD) findings of joint and tendon involvement of the hand and wrist in patients with SLE arthritis. Seventeen patients with SLE and hand involvement were examined. HRUS of the wrist, 2nd and 3rd MCP joints, 3rd PIP joint and 2nd, 3rd and 4th finger flexor tendons were studied in the dominant hand for each patient. Sixteen (94%) patients had joint effusion or synovial hypertrophy in the wrist. Twelve (71%) patients had joint effusion or synovial hypertrophy in 2nd or 3rd MCPJs. Eight (47%) patients had erosion at 2nd or 3rd MCPJs. In three cases erosions were not present radiologically. Eleven (65%) patients had evidence of tenosynovitis. In SLE, HRUS with PD detects a high prevalence of inflammatory pathology in the tendons and synovium of the hand and wrist, and a high prevalence of MCP joint erosions. HRUS offers a sensitive, real-time and readily repeatable assessment of soft-tissue, inflammatory and bony changes in SLE hands.

The role of imaging in the evaluation of joint involvement in 102 consecutive patients with systemic lupus erythematosus

“…Secondly, joint deformities are observed in up to 35% of patients and appear to be associated with difficulties in performing daily activities and may require surgery [10]. Finally, ultrasound studies have shown an unexpected high prevalence of synovitis, tenosynovitis and erosions also in SLE patients (Table 4) [13][14][15][16].…”

“…Inflammatory alterations have been detected by US in the hand or wrist in up to 80% of unselected SLE patients and in more than 90% of patients with joint involvement [12][13][14][15][16]. Moreover, in the few small studies on SLE, MRI demonstrated good performances in the identification of structural damage and bone marrow edema (BME) which have been described in up to 94% and 14%, respectively, of patients with joint involvement [17][18][19].…”

Plasma IL-6 levels correlate with clinical and ultrasound measures of arthritis in patients with systemic lupus erythematosus

“…[7][8][9] The details of some of these studies have been reviewed elsewhere, 10 but all studies noted a higher than expected prevalence of synovitis, tenosynovitis and erosions than was estimated from clinical examination. The presence of erosions can obscure the boundary between SLE and rheumatoid disease.…”

Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases

“…connective tissue diseases or vasculitis) it has not been used or has been poorly applied. The role of US in SLE has been reported by two studies which show the high frequency of subclinical joint involvement [54,55]. Also preliminary studies on the evaluation of knee and hands in Sjögren syndrome gave promising results [56,57].…”