Staging and follow-up of rheumatoid arthritis of the knee. Comparison of sonography, thermography, and clinical assessment.

Abstract

Twenty patients with longstanding polyarticular rheu~ matoid arthritis (including knee involvement) were se~ lected for this study. The severity of the knee synovitis was assessed before and during treatment (with intraarticular corticosteroid injections) using clinical scores, sonography, and thermography. In all patients, the in· flammation regressed during treatment. During followup, the quantity of synovial fluid, as measured sonographically 10 days after the start of therapy, correlated Q uantification of pain and inflammation in rheumatoid arthritis is a difficult clinical problem; 1 as a result, any evaluation based on patient symptoms is fraught with error. A standardized and reproducible method of grading both the severity of disease and the response to treatment is sorely needed.1.2In the last 20 years, various methods have been proposed to assess the severity of articular involvement, including radioisotope scanningM and thermography.5-7 More recently, the use of sonography and magnetic resonance has been suggested. a-u The aim of the present study is to compare the utility of the sonographic parameters, synovial thickness and 7:561, 1988) intra-articular fluid, with the clinical and thermographic rating systems, 2.5;7 both before and during treatment of rheumatoid arthritis of the knee. MATERIALS AND METHODSSixteen women and four men aged 40 to 73 (mean 59 years) were included in this study. All patients had classical rheumatoid arthritis and were classified according to the grading system of the American Rheumatism As· sociation. u All patients had persistent and disabling knee symptoms despite control of the articular symptoms elsewhere by conventional drug therapy.The mean duration of the rheumatoid arthritis in our group was 10 years (range 2 to 26 years). The duration of the acute exacerbation of knee arthritis ranged between 8 and 52 weeks (mean 21 weeks).According to the rating system of the American Rheumatism Association, eight patients were in stage 1 and 12 were in stage 2. uThe patients were assessed on day 0 (before treatment) and at 10 days and three months after treatment

Chondrocalcinosis: Sonographic study of the knee

“…In CC changes of synovial membrane (thickening, synovial villi, effusion) were similar to those found in inflammatory diseases (14)(15)(16)(17); those findings show that CC is a disease with inflammatory factors which often attack the AC with degenerative changes caused by old age of patients (18)(19). Moreover synovial phlogosis may increase cartilaginous damage and it could justify the thinning of cartilage in CC, which is similar to that of serious osteoarthritis.…”

Utilização da imagem infravermelha em reumatologia

“…No tratamento da sinovite, foi descrita a complementação da imagem térmica na avaliação ultra-sonográfica, fornecendo informação da gravidade da resposta imunológica em paralelo à avaliação ultra-sonográfica da quantidade do fluido sinovial (47) .…”

Prospective sonographic and arthroscopic evaluation of proliferative knee joint synovitis.

“…Sonographic and arthroscopic findings were well Figure 6 Sonographic (A) and arthroscopic (8) views of knee joint synovitis in a patient with psoriatic arthritis. Transverse scan (A) through the SPR (patient in recumbent position; knee joint in flexion) shows enlarged SPR with small fluid loculations and abundant solid material, partially arranged in overlapping layers, which correspond in 8 to the alternating fibrous sheets, set parallel to each other.…”

“…Although ultrasonography hils long been used in the diagnosis of inflammatory joint diseases, an exact sonographic morphologic definition of synovial proliferation in knee joint synovitis, based on a reliable judgment using direct anatomic visualization as the gold standard, is still lacking. Nevertheless, sonography has recently been recognized as a very accurate means of assessing soft tissue changes in the hand and knee in rheumatoid arthritis patients in relation to variations in disease activity.7· 8 The object of this study was to define the diagnostic parameters for the sonographic definition of knee joint synovial proliferation in rheumatoid and psoriatic arthritis in terms of an accurate evaluation of synovitic knee joint morphology and synovial thickness. We carried out a prospective study in which sonographic morphologic pictures, topography, and the nature of synovial proliferation were compared with anatomic visualization during arthroscopy.…”