Knee joint synovitis in Sjo¨gren's syndrome. Sonographic study

Abstract

Ultrasound detects effusion and synovial proliferation caused by synovitis. The study was undertaken to evaluate the signs of synovitis in patients with primary Sjögren's Syndrome (SS). Joint effusion was detected and synovial thickness was measured in the suprapatellar synovial bursa. Results have been compared with those obtained by sonographic assessment of knee joint in patients with secondary SS and RA. with secondary SS and connective tissue diseases, with RA, and in healthy subjects. Synovial thickening was demonstrated in all the diseases (higher grades of thickening were found in secondary SS with RA and in RA). Joint effusion was present with significantly higher frequency in secondary SS with RA and in RA. Results demonstrated signs of slight synovitis in primary SS. More severe synovitis was found both in secondary SS with RA and in RA. This is the first sonographic study demonstrating slight synovitis in primary SS.

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

“…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]. Finally, MSUS, by enabling visualization of muscle fibre fine details and the presence of interstitial edema, can disclose the typical inflammation signs of myositis, even if with less sensitivity than MRI, and guide the needle for muscular biopsy [58][59][60].…”

Intra-articular methotrexate in the treatment of rheumatoid arthritis and psoriatic arthritis: a clinical and sonographic study

“…The US analysis reliably detects both abnormalities and it is thus considered an accurate imaging method for the study of synovitis [19,[27][28][29]. Previous studies demonstrated that magnetic resonance analysis of a single sagittal slice and US measurements of synovial thickness in the suprapatellar bursa are reliable and accurate methods for the quantification of the severity of the inflammatory process in RA and in Sj6gren's syndrome patients [19,30,31].…”

“…According to previous studies [19], thickness of the synovial membrane was considered abnormal when higher than 3 ram. Joint effusion, secondary to synovitis, was diagnosed when hypoanechoic fluid collection was shown within the articular space [19,25]. Finally, the presence of Baker's cyst was ascertained when fluid distension of the gastrocnemiosemimembranous bursa was demonstrated.…”

“…Synovial thickness was measured with the patient supine and the knee in neutral position as previously described [19,25]. Measurements were done on the posterior wall of the synovial membrane, as it is better defined than the anterior wall, 2 cm above the superior pole of the patella, both in the transverse and longitudinal scans.…”

“…Ultrasonography (US) was chosen as the imaging modality of reference, since it has been successfully applied, in recent years, to the examination of joint alterations in many rheumatic disorders. In particular, US is currently considered a reliable imaging technique for the detection of joint effusion and synovial proliferation [19,20], which represent two of the main consequences of synovitis [21,22]. Moreover, due to the frequent communication between the gastrocnemiosemimembranous bursa and knee joint cavity, Baker's cysts can be frequently detected by US in the popliteal fossa when effusion is present.…”