Is painless synovitis different from painful synovitis? A controlled, ultrasound, radiographic, clinical trial

Abstract

OBJECTIVE:This study compares the clinical, ultrasonography, radiography, and laboratory outcomes of painless and painful chronic synovitis in patients with established rheumatoid arthritis.METHODS:This cross-sectional study involved 60 patients with rheumatoid arthritis and synovitis in the metacarpophalangeal joints; 30 of the patients did not experience pain, and 30 had experienced pain for at least 6 months prior to the study. The radiocarpal, distal radioulnar, and metacarpophalangeal joints were evaluated using the ultrasound gray scale, power Doppler, and radiography. Past and present clinical and laboratory findings were also evaluated.RESULTS:There were no statistically significant differences between the groups for most of the outcomes. The group with pain scored worse on the disease activity indices (e.g., DAS 28 and SDAI), function questionnaires (HAQ and Cochin), and pinch strength test. A logistic regression analysis revealed that the use of an immunobiological agent was associated with a 3-fold greater chance of belonging to the group that experienced pain. The painless group had worse erosion scores in the second and fifth metacarpophalangeal with odd ratios (ORs) of 6.5 and 3.5, respectively. The painless group had more cartilage with grade 4 damage in the third metacarpophalangeal.CONCLUSIONS:The rheumatoid arthritis patients with both painless and painful synovitis exhibited similar disease histories and radiographic and ultrasound findings. However, the ultrasonography evaluation revealed worse scores in the second and fifth metacarpophalangeal of the synovitis patients who did not experience pain.

Cartilage evaluation by ultrasonography in patients with rheumatoid arthritis: a scoping review

“…The metacarpophalangeal (MCP) joint was the most commonly assessed joint, with 16 (55%) studies assessing it [ 3 , 10 , 11 , 16 – 18 , 20 , 24 – 27 , 29 , 30 , 34 – 36 ]. Five studies assessed the proximal interphalangeal (PIP) joint [ 3 , 17 , 26 , 29 , 34 ].…”

“…Table 3 lists the US evaluation methods used in the studies. US evaluation of the cartilage included 15 studies that measured cartilage thickness [ 3 , 12 , 13 , 18 , 19 , 21 , 23 , 28 , 29 , 32 – 37 ], 10 that assessed it binarily [ 11 , 12 , 14 , 15 , 18 , 22 , 23 , 26 , 27 , 36 ], and 15 that assessed it semi-quantitatively [ 10 – 13 , 16 , 17 , 20 , 24 , 25 , 27 , 30 , 31 , 34 – 36 ]. Ten studies assessed two cartilage evaluation methods [ 11 – 13 , 18 , 23 , 27 , 28 , 34 – 36 ], and three examined the relationship between them [ 34 – 36 ].…”

“…The scale was developed by Taskforce of the Outcome Measures in Rheumatology Ultrasound Working Group (OMERACT US WG) [ 17 ]. Seven studies [ 10 , 11 , 16 , 24 , 25 , 30 , 35 ] used a 5-point scale of 0–4, which was developed by Disler et al [ 38 ]. One study [ 31 ] used a 6-point grading scale of 1–6, based on the grading for OA by Lee et al [ 39 ], and three studies used the original grading.…”

“…Fourteen studies examined the associations between clinical and demographic data [ 3 , 11 , 15 , 16 , 21 , 24 , 26 , 27 , 29 , 32 – 34 , 36 , 37 ] (Table 5 ). The main factors examined were age, sex, disease duration, and disease activity.…”

A Case of Painless Elderly-Onset Rheumatoid Arthritis

“…Joint pain affects the daily lives of the majority of patients with RA, even those established on treatment [ 9 ]. Cases of painless synovitis in RA are rare but have been reported and have been shown to follow a similar disease progression to those with pain [ 10 ]. This report demonstrates a case of RA with a complete lack of pain as well as entirely non-tender joints on palpation.…”