Title:Contribution of Ultrasonography of Hands and Wrists in Early Rheumatoid Arthritis
Volume: 17
Issue: 3
Author(s): Saoussen Miladi*, Wafa Hamdi, Kaouther Maatallah, Asma EL Elj, Mouna Chelli, Dhia Kaffel and Mohamed Montasser Kchir
Affiliation:
- Rheumatology Department, Faculty of Medicine of Tunis, University of Tunis El Manar, Mongi Slim Hospital, La Marsa,Tunisia
Keywords:
Ultrasound, Synovitis, early diagnosis, Rheumatoid Arthritis, undifferentiated arthritis, data accuracy.
Abstract:
Objectives: Early diagnosis and management of rheumatoid arthritis (RA) have improved
the outcome of patients. In the last decade, musculoskeletal Ultrasonography (MSUS) had
demonstrated its superiority over clinical examination in detecting synovitis in RA. We conducted
this present study in order to assess the added value of MSUS in diagnosing early RA.
Methods: A cross-sectional study was conducted, including one hundred patients diagnosed RA
based on the physician's opinion and presenting with inflammatory arthralgia or swollen joints for
more than 6 weeks and less than 2 years. Patients underwent clinical, laboratory, and radiographic
examination. MSUS was performed by a radiologist blinded to clinical findings assessing 22 joints
of hands. A US ACR/EULAR 2010 score was calculated by replacing the swollen joints of hands
with those expressing synovitis in Greyscale US. Agreement between clinical and US ACR/EULAR
score was assessed.
Results: Among the 2200 joints scanned by the US, synovitis was detected in 81% of patients, an
intra-articular effusion in 36% patients, and PD signals in 51% of patients. Flexor tenosynovitis
was present in 55% of patients and extensor tenosynovitis in 59% of patients. Synovitis and PD signals
were more often detected in wrists. PD mode was found to be correlated with CRP results
(r=0,302, p=0,023). The MSUS assessment has demonstrated synovitis on 71% (N=22) patients
who were free of swollen joints on clinical examination. Through 13 patients expressing
monoarthritis at clinical examination, 69% (N=9) patients were reclassified with oligo or polyarthritis.
By adding US data, a further 13 patients accomplished the ACR/EULAR score. A good level of
agreement was found between clinical and US ACR/EULAR criteria (k=0,684, p=0,001).
Conclusion: MSUS is an inexpensive and accessible examination tool, which should be considered
in patients in the onset of an inflammatory rheumatic disease in order to benefit of the window of
opportunity and reach remission.
