The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: A comparison with conventional radiography

Abstract

Objective The ability to make an early, accurate diagnosis of rheumatoid arthritis (RA) has become increasingly important with the availability of new, expensive, and targeted therapies. However, plain radiography, the traditional method of detecting the characteristic bone erosions and an important adjunct in establishing a diagnosis of RA, is known to be insensitive. This study compared sonography, a modern imaging technique, with conventional radiography for the detection of erosions in the metacarpophalangeal (MCP) joints of patients with RA. Methods One hundred RA patients (including 40 with early disease) underwent posteroanterior radiography and sonography of the MCP joints of the dominant hand. Twenty asymptomatic control subjects also underwent sonography. Erosion sites were recorded and subsequently compared using each modality. Magnetic resonance imaging (MRI) was performed on the second MCP joint in 25 patients with early RA to confirm the pathologic specificity of sonographic erosions. Intraobserver reliability of sonography readings was assessed using video recordings of 55 MCP joint scans of RA patients, and interobserver reliability was assessed by comparing 160 MCP joint scans performed sequentially by 2 independent observers. Results Sonography detected 127 definite erosions in 56 of 100 RA patients, compared with radiographic detection of 32 erosions (26 [81%] of which coincided with sonographic erosions) in 17 of 100 patients (P < 0.0001). In early disease, sonography detected 6.5‐fold more erosions than did radiography, in 7.5‐fold the number of patients. In late disease, these differences were 3.4‐fold and 2.7‐fold, respectively. On MRI, all sonographic erosions not visible on radiography (n = 12) corresponded by site to MRI abnormalities. The Cohen‐kappa values for intra‐ and interobserver reliability of sonography were 0.75 and 0.76, respectively. Conclusion Sonography is a reliable technique that detects more erosions than radiography, especially in early RA. Sonographic erosions not seen on radiography corresponded to MRI bone abnormalities. This technology has potential in the management of patients with early RA/inflammatory arthritis and is likely to have major implications for the future practice of rheumatology.

Sonographic evaluation of the temporomandibular joints in juvenile idiopathic arthritis

“…Capsule thickness was measured as the distance between this line and the bone [4]. The condylar profile was visualized as a hyperechoic line with or without alterations suggestive of erosion, osteophyte formation, or bone remodelling.…”

Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

“…It has been increasingly used in rheumatologic practice and research in the last decade, especially in small joints of the hands and fingers (1)(2)(3). By contrast, large joints have not been extensively studied, and knee involvement has only been incorporated in a 12-joint US score proposed by Naredo and colleagues (3).…”

“…By contrast, large joints have not been extensively studied, and knee involvement has only been incorporated in a 12-joint US score proposed by Naredo and colleagues (3). Evaluation of early soft tissue lesions and bony erosions in inflammatory joint disease is a strength of this method compared to conventional radiographs, which was demonstrated by Wakefield et al more than 10 years ago (2). In contrast to magnetic resonance imaging (MRI), there are almost no limiting factors, such as pacemakers, metal implants, or claustrophobia.…”

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

“…As a result, it is now possible to demonstrate the level of inflammatory activity present within synovial tissue, differentiating between acute and chronic inflammation [15]. US is of particular benefit when searching for bone erosion and cartilaginous change in early phases of the disease process, thereby allowing a diagnosis to be confirmed and the progression of the disease to be followed [16]. Furthermore, multiplanar scanning permits examination of superficial areas which cannot be studied satisfactorily with conventional X-ray [17,18].…”