Prevalence of subclinical synovitis of the hand in patients with systemic lupus erythematosus

Abstract

Objectives To determine the prevalence of subclinical synovitis in Lupus patients without peripheral joint symptoms, in those with arthralgias without arthritis and those with episodic arthritis but without radiological structural damage. Methods We conducted a multicentre cross-sectional study. Patients with lupus from those three categories were recruited to take part in a greyscale ultrasound scan performed by an expert blinded rheumatologist. Data from a historical control group from a previous study was also included for comparisons. Images were assessed separately in order to determine the presence and level of synovitis following Eular recommendations. Results Ninety-six patients (88.5% female) with an average age of 40 ± 6.2 years old, were included. SLICC/ACR score was 0.6 ± 0.3 in the group without joint symptoms (group 0), 0.8 ± 0.3 in the group with arthralgias (group I) and 1.1 ± 0.4 in the group with episodic arthritis. The global prevalence of subclinical synovitis was 38.5%. In group 0, that prevalence was 30%. The time since onset of symptoms of patients with subclinical synovitis was longer than the rest of the patients (9.4 ± 2.2 vs 6.5 ± 4.0 years, P < 0.001). No other remarkable association was founded with clinical features of the disease. Conclusions This is the first study focused on subclinical synovitis in patients with lupus. Other previous studies had included patients with different levels of arthropathy. Subclinical synovitis does exist in lupus patients in over a third of patients. Its meaning remains unclear and must be a topic of further studies.

The frequency and characteristics of ultrasonographic ankle joint involvement in systemic lupus erythematosus: A prospective cross-sectional single-center study

“…[6,10] Most studies conducted to date have found a significant subclinical joint involvement of metacarpophalangeal, proximal interphalangeal, and wrist joints in patients with SLE leading to the conclusion that reliance only on physical examination of the joints may underestimate the presence of active joint inflammation. [8,16–19] On the other hand, subclinical synovitis did not show a clear correlation with disease activity parameters. Although earlier studies mainly found mild changes in asymptomatic patients, [17] a recent US study reported subclinical synovitis grade ≥2 in 20.8% of patients.…”

Update on Current Imaging of Systemic Lupus Erythematous in Adults and Juveniles

“…The prevalence of subclinical synovitis in heterogenous studies, including—in most of them—consecutive, both symptomatic and asymptomatic, patients with lupus, ranges between 10% and 95% [ 8 ]. Honghu et al [ 2 ], in a retrospective study, aimed to compare the role of hand and wrist US in diagnosing subclinical synovitis in SLE patients.…”

“…Twelve patients (29.3%) demonstrated knee joint involvement. Guillen et al [ 8 ], in a multicenter cross-sectional study, found US features of arthritis in hands in about one-third of asymptomatic SLE patients with synovial thickening on gray scale images, while synovial hyperemia on power Doppler US was seen in one-fifth of the patients. The global prevalence of subclinical synovitis in the group with arthralgias was 38.2%.…”

“…In the group without joint symptoms, that prevalence was 30%. No erosions or tendon ruptures were found in any patient [ 8 ]. Subclinical synovitis was reported in one study in 58.3% of SLE patients without joint involvement, through the US of the wrist and second and third MCP joints [ 8 ], and in 77% of SLE asymptomatic patients, with synovial hyperemia in 23% [ 8 ].…”

“…Involvement of the MSK system is also often (in c.a. 50% of patients) the earliest manifestation of SLE [ 1 , 4 , 7 , 8 ]. Any joint may be affected, however, like in rheumatoid arthritis (RA), but most commonly, there is symmetric polyarthritis or oligoarthritis involving the hands, wrists, knees, and less frequently, the feet, ankle, shoulder, and elbow joints [ 2 , 6 , 9 ].…”