Ultrasound verified inflammation and structural damage in patients with hereditary haemochromatosis-related arthropathy

Abstract

BackgroundChronic arthropathy occurs in approximately two thirds of patients with hereditary haemochromatosis (HH). The aim was to study inflammatory and structural lesions in patients with HH with (HH-A) and without arthropathy (HH-WA) using ultrasonography.MethodsThis was a cross-sectional study of 26 patients with HH-A, 24 with HH-WA and 37 with hand osteoarthritis (HOA). Clinical examination was performed in 68 joints, and we retrieved data on hand function, pain and global disease activity (all using a visual analogue scale (VAS)), morning stiffness and ferritin levels. Standard x-ray and ultrasound were conducted in 36 joints (hands, hips, knees and ankles), and we graded grey scale synovitis (GSS), power Doppler ultrasound (PD), osteophytes, erosions, tenosynovitis and cartilage damage semi-quantitatively in accordance with prior publications.ResultsUltrasound revealed a high proportion of inflammatory changes in HH-A; GSS was found in 96.2% and PD signals in 80.8% of patients (median GSS score 9, PD score 2.5). The frequency of these findings was similar in HOA. Inflammation was also common in HH-WA, yielding GSS in 83.3% and PD signals in 50.0% of patients. Cartilage damage was most prominent in HH-A as compared to HH-WA and HOA (median scores 11.0, 2.5 and 2.0, respectively). The prevalence and extent of erosions and osteophytes were similar in all groups. None of the ultrasound scores was associated with pain or function; GSS, PD, osteophyte and cartilage scores correlated with x-ray-verified structural damage.ConclusionA high prevalence of ultrasound-verified inflammation and cartilage damage was found in HH-A, and to a lesser extent in HH-WA. These findings were associated with x-ray-verified damage but not with clinical scores of pain and function.

Reliability of detection of ultrasound and MRI features of hand osteoarthritis: a systematic review and meta-analysis

“…Fifty-two studies met the inclusion criteria. However, two studies were later excluded because one performed reliability assessment on fusion of US and MRI images (fusion imaging) [ 22 ] and the other performed reliability on finger, knee, hip and ankle joints, and did not provide separate estimates for individual joint [ 23 ]. This left 50 studies for inclusion in the final analysis (29 used US only, 17 used MRI only and four involved both imaging modalities.)…”

Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging

“…All these data suggest that local symptoms in active dactylitis are linked with extracapsular lesions, particularly flexor tenosynovitis and STOe, highlighting the central role of extra-articular structures in the genesis of digit pain. The sonographic evidence of joint synovitis does not seem to correlate with pain in the digit; this is not surprising since other rheumatic diseases demonstrate this same quality (Figure 2) [60][61][62].…”

Hämochromatose und Arthropathie

“…Subklinische Gelenkerkrankungen können bei einigen Patienten mittels Ultraschall nachgewiesen werden. Die Ultraschalluntersuchung von 64 Gelenken in 24 HH-Patienten ohne Arhropathie zeigte Hinweise auf eine anhaltende subklinische Entzündung und Knorpelschädigung mit Erosionen, wenn auch in geringerem Ausmaß als bei Patienten mit HH-Arthropathie [49].…”