Ultrasound in clinically suspect arthralgia: the role of power Doppler to predict rheumatoid arthritis development

Collada, J. Molina; Gloria, Katerine López; Castrejón, Isabel; Nieto‐González, Juan Carlos; Rivera, Javier; Montero, Fernando; González, Carlos; Álvaro‐Gracia, José María

doi:10.1186/s13075-021-02685-7

Cited by 10 publications

(3 citation statements)

References 26 publications

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“…A major intrinsic limitation of our study is represented by the fact that most of the studies focused on the assessment of entheses, with limited information on the joints and no information on tenosynovitis. While in spondyloenthesoarthritis enthesitis has been identified as the primary lesion characterizing the disease process, tenosynovitis is emerging as a possible early lesion in new-onset peripheral inflammatory pain ( 36 ), and its low prevalence in healthy subjects suggests specificity for arthritis ( 37 ). In addition, tenosynovitis was the only lesion presenting with a different frequency in psoriatic patients with or without arthralgia ( 16 ), thus it might represent an interesting feature to assess also in IBD.…”

Section: Discussionmentioning

confidence: 99%

Musculoskeletal Ultrasound to Identify Subclinical Joint and Periarticular Involvement in Patients With Inflammatory Bowel Disease: A Systematic Literature Review

et al. 2022

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BackgroundMusculoskeletal ultrasonography identifies subclinical joint and entheseal inflammation, and it might be of value in patients with inflammatory bowel diseases (IBD), which are at higher risk of inflammatory arthropathy and disability. Our aim was to retrieve the evidence on the applications of ultrasound in patients with non-arthropathic IBD.MethodsStudies enrolling patients with IBD without arthritis, undergoing ultrasound of joints, tendons or entheses were eligible. The outcomes of interest encompassed the frequency of ultrasound-detected lesions, their accuracy in diagnosing arthritis, their prognostic role and sensitivity to change. All study types, excluding case reports, case series and narrative reviews, were included. Search strategies were applied in PubMed and Embase. Abstract and full-texts were evaluated by pairs of reviewers. The risk of bias was evaluated through the Newcastle-Ottawa scale or the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2. The protocol was registered in PROSPERO (CRD42021264972).ResultsOut of 2,304 records, eight studies were included, all reporting the frequency of lesions, while only three evaluated also the diagnostic accuracy. All studies had a cross-sectional design, with no evidence on prediction or follow-up. All studies evaluated the entheses, while only three the joints. The most common chronic lesions were entheseal thickening (up to 81.5%) and enthesophytes (67.9%), while entheseal erosions were present in 16%−17% of patients. Among inflammatory lesions, power Doppler was reported in 14%−67% of patients. There were no differences among Crohn's disease or ulcerative colitis and depending on disease activity, while there were contrasting results on different disease durations. When evaluating the diagnostic performance, the best specificity for a diagnosis if IBD was 0.88 (95%CI, 0.8–0.94) for joint abnormalities. Also, the best sensitivity was 0.88 (95%CI, 0.76–0.95) for entheseal lesions. No studies assessed of the combination of lesions. Due to the limited number of studies, meta-analyses were not performed.ConclusionsDespite the possible value of ultrasound in IBD, there is limited evidence deriving from cross-sectional studies. Longitudinal studies are needed to clarify the role of this technique, while its current placement might be that of complementing clinical assessment, in particular in early intestinal disease.

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Section: Discussionmentioning

confidence: 99%

Musculoskeletal Ultrasound to Identify Subclinical Joint and Periarticular Involvement in Patients With Inflammatory Bowel Disease: A Systematic Literature Review

et al. 2022

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“…The ability of US tenosynovitis to predict IA has been less well studied than with MRI and has shown mixed results. Molina Collada et al found that in a cohort of CSA patients PD tenosynovitis at baseline was the only independent predictor of RA and IA development ( 32 ). In contrast van de Stadt et al did not find that US tenosynovitis was significantly predictive of IA progression at joint or patient level ( 29 ).…”

Section: Which Imaging Technique?mentioning

confidence: 99%

When and how should we use imaging in individuals at risk of rheumatoid arthritis?

Matteo

Mankia

2022

Front. Med.

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In recent years rheumatologists have begun to shift focus from early rheumatoid arthritis (RA) to studying individuals at risk of developing the disease. It is now possible to use blood, clinical and imaging biomarkers to identify those at risk of progression before the onset of clinical synovitis. The use of imaging, in particular ultrasound (US) and magnetic resonance imaging (MRI), has become much more widespread in individuals at-risk of RA. Numerous studies have demonstrated that imaging can help us understand RA pathogenesis as well as identifying individuals at high risk of progression. In addition, imaging techniques are becoming more sophisticated with newer imaging modalities such as high-resolution peripheral quantitative computed tomography (HR-pQRCT), nuclear imaging and whole body-MRI (WB-MRI) starting to emerge. Imaging studies in at risk individuals are heterogeneous in nature due to the different at-risk populations, imaging modalities and protocols used. This review will explore the available imaging modalities and the rationale for their use in the main populations at risk of RA.

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“…Musculoskeletal ultrasound (MSUS) at present time plays a crucial role in the diagnosis and treatment of the rheumatic diseases (8) . The presence of synovitis detected by MSUS is helpful in the diagnosis of undifferentiated arthritis (UA) and in inflammatory arthritis it is predictive of persistent disease, joint damage, and acute disease flare (9) . It has dramatically improved joint and tendon evaluation in rheumatoid arthritis (RA) and other inflammatory diseases.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Hand Features in Systemic Sclerosis and Rheumatoid Arthritis Patients by Diagnostic Ultrasound and its Correlation to Disease Activity, Clinical and Radiological Findings

Asy

Abdelkareem

Wahab

et al. 2022

SJMS

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Introduction and Aim: Imaging evaluation of the rheumatoid arthritis and systemic sclerosis represents a significant part in disease evaluation and follow up. However, it had many limitations and new tools are introduced continuously. The current work aimed to compare ultrasound characteristics of the hand involvement in systemic sclerosis (SSc) and rheumatoid arthritis (RA). Patients and methods: The study included 30 SSc and 40 RA patients. All were evaluated by the full history taking, detailed clinical examination, disease activity scores and the health assessment questionnaires were completed. All necessary laboratory investigations were performed. Finally, radiological examination (plain X-rays and ultrasound for joints of hands and wrist) was performed. Results: Patient age ranged from 22 to 58 years, and RA patients were significantly older, with female sex predominance. SSc was of diffuse (30%) and (70%) were of limited type. The disease activity of RA ranged from 2 to 9, while disease activity of SSc ranged between 1.3 to 3.5. In the SSc group, 56.7% had active disease compared to 40% in RA groups. Patients in the SSc group had a degree of disability, while 82.5% of patients in the RA group had mild- to- moderate disability. Ultrasound examination revealed that, synovitis was significantly increased in RA when compared to the SSc group (55.0% vs 23.3%). The sclerosing pattern of tenosynovitis was significantly increased in SSc than the RA group (92.3% vs 0.0% respectively). Results of ultrasound completely coincides with results of MRI. Finally, there was statistically significant, moderate, proportional correlation between ultrasound and each of erythrocyte sedimentation rate (ESR), and disease activity scores. Conclusion: Ultrasound hand examination in scleroderma and RA is more accurate than separate clinical or X-ray examinations. However, it could not completely substitute clinical examination. But it is a suitable add on especially in detection of early disease activity.

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Ultrasound in clinically suspect arthralgia: the role of power Doppler to predict rheumatoid arthritis development

Cited by 10 publications

References 26 publications

Musculoskeletal Ultrasound to Identify Subclinical Joint and Periarticular Involvement in Patients With Inflammatory Bowel Disease: A Systematic Literature Review

Musculoskeletal Ultrasound to Identify Subclinical Joint and Periarticular Involvement in Patients With Inflammatory Bowel Disease: A Systematic Literature Review

When and how should we use imaging in individuals at risk of rheumatoid arthritis?

Comparison of Hand Features in Systemic Sclerosis and Rheumatoid Arthritis Patients by Diagnostic Ultrasound and its Correlation to Disease Activity, Clinical and Radiological Findings

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