Ultrasound detects subclinical joint inflammation in the hands and wrists of patients with systemic lupus erythematosus without musculoskeletal symptoms

Abstract

ObjectivesTo assess the prevalence and severity of ultrasonographic abnormalities of the hand and wrist of asymptomatic patients with systemic lupus erythematosus (SLE) and compare these findings with those from patients with SLE with musculoskeletal signs or symptoms and healthy controls.MethodsWe conducted a prospective cross-sectional study that evaluated bilaterally, with grey-scale and power Doppler (PD) ultrasound (US), the dorsal hand (2nd to 5th metacarpophalangeal and 2nd to 5th proximal interphalangeal joints) and wrist (radiocarpal, ulnocarpal and intercarpal joints) of 30 asymptomatic patients with SLE, 6 symptomatic patients with SLE and 10 controls. Synovial hypertrophy (SH) and intra-articular PD signal were scored using semiquantitative grading scales (0–3). Individual scores were graded as normal (SH≤1 and PD=0) or abnormal (SH≥2 or PD≥1). Global indexes for SH and PD were also calculated. US findings were correlated with clinical and laboratory data and disease activity indexes.ResultsUS detected SH (score ≥1) in 77% asymptomatic patients with SLE, mostly graded as minimal (score 1: 63%). 23% of the asymptomatic patients with SLE showed abnormal US PD findings (SH≥2 or PD≥1). SH was present in all symptomatic patients with SLE, mostly graded as moderate (grade 2: 67%), and with associated PD signal (83%). SH (score 1) was identified in 50% of controls, however, none presented abnormal US PD findings. SH index in the asymptomatic SLE group was higher than in the control group (2.0 (0–5) vs 0.5 (0–2), median (range), p=0.01) and lower than in the symptomatic SLE group (7.0 (4–23), median (range), p<0.001). No significant correlation was demonstrated between US PD findings and clinical or laboratory variables and disease activity indexes.ConclusionA small subgroup of asymptomatic patients with SLE may present subclinical joint inflammation. Global US scores and PD signal may be important in disease evaluation and therapeutic monitoring.

Involvement of the wrist and hand joints and tendons in an Egyptian systemic lupus erythematosus cohort

“…Ten (62.5%) out of 16 asymptomatic patients had a sonographic evidence of synovitis. This finding has recently been described in the literature by "subclinical synovitis" [8,9,13,33]. No significant difference was found between both patient groups regarding PD index probably because they had comparable cumulative dose of Cs intake.…”

“…No significant difference was found between both patient groups regarding PD index probably because they had comparable cumulative dose of Cs intake. Ruano et al [8] suggested that the high prevalence of steroid use among the SLE population could reduce the global inflammatory burden and result in lower prevalence and grading of the US PD findings.…”

“…Some authors have reported subclinical ultrasonographic (US) synovitis in asymptomatic SLE patients with a high percentage of tendon involvement [8][9][10]. Piga et al in 2016 [11] found that baseline power Doppler (PD) synovitis score predicted MSK flare within 2 years from US examination.…”

Association of CXCL13 serum level and ultrasonographic findings of joints in patients with systemic lupus erythematosus and Jaccoud’s arthropathy

“…29 On the other hand other recent studies have shown that the use of Power Doppler could facilitate this identification in lupus patients. 30…”

Recognition and management of systemic lupus erythematosus

“…9 Radiologically <5% of patients with SLE have erosions, but evaluation by ultrasound reveals a broad spectrum of changes that also involve anatomic structures not recognised by X-rays, including entheses and tendons. 11 Another important clinical concern is avascular necrosis, which can also cause joint pain and needs to be considered in patients on corticosteroids.…”