Ultrasound of Synovitis in Rheumatoid Arthritis: Advantages of the Dorsal over the Palmar Approach to Finger Joints

Witt, Matthias; Mueller, Felix; Weinert, Peter; Nigg, Axel; Reindl, Christiane; Proft, Fabian; Schulze‐Koops, Hendrik; Grünke, Mathias

doi:10.3899/jrheum.131027

Cited by 27 publications

(16 citation statements)

References 27 publications

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“…Probably the same explanation is valuable for the grade 1 synovitis, due to its incipient pathologic vascularization: in the presence of grade 1synovitis the PD signal was much frequent detected in the dorsal side (28.1%) comparing with palmar side (3.7%) [12]. Also, Witt et al [24] found in patients with newly diagnosed rheumatoid arthritis (RA) more pathologic findings in grey-scale US from the palmar approach and more frequent PD signals from the dorsal approach of the finger joints. In the study realized by Zufferey et al [25] the grade 1 PD signal was found only in 5% of normal volunteers (the authors did not specify the joints where this was found) and they considered to be relevant this grade of PD vascularization for the evaluation of remission in RA patients.…”

Section: Discussionmentioning

confidence: 88%

Ultrasonography of the metacarpophalangeal joints in healthy subjects using an 18 MHz transducer.

Fodor

Felea²,

Popescu³

et al. 2015

Med Ultrason

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Aim: To evaluate the metacarpophalangeal (MCP) joints (MCP2 and 5) in healthy subjects by ultrasonography (US) using a high frequency transducer (18 MHz) and to verify the interobserver agreement. Material and methods: We enrolled 50 healthy volunteers (37 women, age between 30-58 years, mean age 41.7 years, divided into 3 groups according to age: 30-39, 40-49, and 50-58 years). The subjects were successively evaluated by 4 rheumatologists: 2 experienced (team A) and 2 beginners (team B) in US. Seven dorsal and palmar longitudinal scanning positions and a supplementary scan for MCP cartilage were performed. The bone surface (erosions, osteophytes), the intra-articular content (synovial thickening and vascularization, 4 grade scale), and the aspect of the metacarpal head cartilage were analyzed. The anterior palmar recess was measured. The time for examination was recorded. Results: Erosions were detected in 7% of joints by team A and 2% by team B (p<0.05, kappa agreement 0.567) in subjects over 40 years. The agreement by team A in the detection of the erosions was very good (kappa value 0.83). A moderate positive correlation was obtained between the presence of erosions and age (r= 0.401, p=0.004). Osteophytes were identified only on the dorsal scan in subjects over 50 years (in 3.5% of joints team A, 1.5% team B, p>0.05, kappa value 0.421). No grade 1 synovitis was observed by team A but 4 joints with grade 1 synovitis were identified by team B (p<0.05) from the dorsal scan. The dimensions of the palmar recess had large distribution (MCP 2 between 0.55-1.3 mm; MCP 5 between 0.6-1.2 mm). No statistical significant differences were obtained when comparing the dimensions of the two hands or the values obtained in agegroups (all p>0.05). No statistical significant correlations were obtained between the dimensions of palmar recess and the body mass index or dominant hand (all p>0.05). No pathological findings were found in the examination of the metacarpal head cartilage. Power Doppler investigation found the presence of grade 1 signal in 2.5% joints by team A and 1.5% by team B (p>0.05) only in the dorsal scans. The mean time for examination was 7.8±1.74 min in team A and 13.78±2.96 min in team B (p<0.05). Conclusions: In healthy subjects pathological findings are occasionally encountered, especially erosions and osteophytes. Using an 18 MHz transducer the aspect of grade 1 synovitis was not encountered in healthy non-inflammatory MCP joints. There is a permanent need for standardized training and examination in musculoskeletal US.

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Section: Discussionmentioning

confidence: 88%

Ultrasonography of the metacarpophalangeal joints in healthy subjects using an 18 MHz transducer.

Fodor

Felea²,

Popescu³

et al. 2015

Med Ultrason

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“…29 A study involving a cohort of 70 patients diagnosed with RA directly compared the dorsal and palmar approaches using PD-US, reporting greater prevalence of 22.1% versus 8.9% and greater double-positive rates, in which both grayscale US and PD-US are simultaneously observed, of 57.5% versus 17.4% for dorsal compared to palmar imaging of PIP joints. 30 Fluorescence tomographic imaging of injected contrast agent indocyanine green in inflamed fingers also concurs, revealing a greater degree of vascularization on the dorsal aspect. 31 This asymmetrical distribution of inflammation makes imaging orientation of joints using noncontact DOI systems of importance, the impact of which has not previously been investigated.…”

Section: Introductionmentioning

confidence: 84%

Detecting inflammation in rheumatoid arthritis using Fourier transform analysis of dorsal optical transmission images from a pilot study

2019

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A clinical need exists for low-cost and noninvasive imaging tools capable of detecting inflammation in the joints of inflammatory arthritis patients. Previous studies have reported an optical contrast between inflamed and noninflamed joints resulting from distinct absorption and scattering properties. Accurate classification using nonocclusion-based continuous wave, transillumination imaging was limited to patient-specific changes during follow-up examination as opposed to single time-point examination, which was attributed to high intersubject variability. In distinction from previous work, optical images were acquired from the dorsal side with illumination on the palmar side and features about the spatial distribution of transmitted light along the joint were assessed using a normalized Fourier transform method. Results using this approach demonstrated an area under receiver operator curve of up to 0.888 for detecting inflammation in a pilot study involving single time-point examination of 144 joints from 21 rheumatology patients. This workflow may enable future development of clinically viable, lowcost devices for assessing inflammation in arthritis patients, without the need for cuff occlusion or comparison to baseline. © The Authors. Published by SPIE under a Creative Commons Attribution 4.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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“…This is especially important when assessing erosive damage, but may also provide some additional information about the inflammatory load. However, applying a dorsal-only approach of the wrist and MCP/PIP/MTP joints, as in our candidate sets, increases feasibility and it has been shown that this projection captures most of the inflammatory findings 25. Also, the main objective of this study was to develop an US joint inflammation score, without focusing on evaluating erosive damage, thus the potential gain by applying several projections is not time efficient.…”

Section: Discussionmentioning

confidence: 99%

First step in the development of an ultrasound joint inflammation score for rheumatoid arthritis using a data-driven approach

et al. 2015

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Ultrasound of Synovitis in Rheumatoid Arthritis: Advantages of the Dorsal over the Palmar Approach to Finger Joints

Cited by 27 publications

References 27 publications

Ultrasonography of the metacarpophalangeal joints in healthy subjects using an 18 MHz transducer.

Ultrasonography of the metacarpophalangeal joints in healthy subjects using an 18 MHz transducer.

Detecting inflammation in rheumatoid arthritis using Fourier transform analysis of dorsal optical transmission images from a pilot study

First step in the development of an ultrasound joint inflammation score for rheumatoid arthritis using a data-driven approach

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