Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: a prospective longitudinal study
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To evaluate and compare sequential ultrasound exams (US) with power-Doppler (PD) to radiography for the detection of synovitis and erosions in patients with early RA.
Radiographs and US with PD of the hands and feet were performed at baseline and 6± 2 months afterwards in 21 early RA patients. Their mean (range) age was 42.6 (21–81) years and the female/male ratio was 4:3; mean disease duration was 9 (1–28) months. Joints assessed were bilateral 2nd and 5th MCPs, 5th MTPs and the most swollen PIP in each hand, for a total of eight joints per patient. Radiographs (PA, lateral and pronated oblique) were read for erosions using the method of Sharp/van der Heijde. On US, erosions were defined as cortical defects greater than 2 mm in diameter with an irregular floor. Synovitis was rated as +1 (increase in joint fluid without synovial hyperemia), +2 (mild blood flow), +3 (moderate blood flow), and +4 (severe blood flow). Two blinded trained assessors read all images.
US detected 15 erosions in 10 patients at baseline and 31 erosions in 12 patients on follow-up; radiographs could detect only one erosion at baseline and five erosions in three patients on follow-up. PD detected synovitis in all patients at baseline and on follow-up. Of the joints found to have synovitis, 64% were identified as such at baseline and 38% on follow-up.
Sequential US can determine disease progression in patients with early RA. Such data may allow the clinician to treat RA patients earlier in the hope of preventing joint damage.
- Egsmose C, Lund B, Borg G, Petterson H, Berg E, Brodin U, et al. Patients with rheumatoid arthritis benefit from early second line therapy: 5 year follow-up of a prospective double blind placebo controlled study. J Rheumatol 1995;22:2208–13.
- Tsakonas E, Fitzgerald AA, Fitzcharles MA, Cividino A, Thorne JC, M’Seffar A, et al. Consequences of delayed therapy with second-line agents in rheumatoid arthritis: a 3 year followup on the hydroxychloroquine in early rheumatoid arthritis (HEAR) study. J Rheumatol 2000;27:623–29.
- Bukhari MA, Wiles NJ, Lunt M, Harrison BJ, Scott DG, Symmons DP, et al. Influence of disease-modifying therapy on radiograhic outcome in inflammatory polyarthritis at five years: results from a large obeservational inception study. Arthritis Rheum 2003;48(1):1–5. CrossRef
- Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 2004;364(19430):263–69. CrossRef
- Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Ostergaard M. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 2004;50:2103–12. CrossRef
- Karim Z, Wakefield RJ, Conaghan PG, Lawson CA, Goh E, Quinn MA, et al. The impact of ultrasonography on diagnosis and management of patients with musculoskeletal conditions. Arthritis Rheum 2001;44:2932–33. CrossRef
- Ostergaard M, Szkudlarek M. Ultrasonography: a valid method for assessing rheumatoid arthritis? Arthritis Rheum 2005;52:733–43. CrossRef
- Scheel AK, Hermann KG, Kahler E, Pasewaldt D, Fritz J, Hamm B, et al. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthritis Rheum 2005;52:681–86. CrossRef
- Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24.
- Sharp JT. Assessment of radiographic abnormalities in rheumatoid arthritis: what have we accomplished and where should we go from here? J Rheumatol 1995;22:1787–91.
- Wakefield RJ, Gibbon WW, Conaghan PG, O’Connor P, McGonagle D, Pease C, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis. A comparison with conventional radiography. Arthritis Rheum 2000;43:2762–70. CrossRef
- Alarcón GS, Moreland LW, Lopez-Ben R. High resolution ultrasound for the study of target joints in rheumatoid arthritis. Arthritis Rheum 2002;46:1969–71. CrossRef
- Kane D, Grassi W, Sturrock R, Balint PV. Musculoskeletal ultrasound—a state of the art review in rheumatology. Part 2: clinical indications for musculoskeletal ultrasound in rheumatology. Rheumatology 2004;43:829–38. CrossRef
- Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 2005;64:375–81. CrossRef
- Altman DG. Practical statistics for medical research. 1st ed. London: Chapman and Hall; 1991.
- Weidekamm C, Koller M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 2003;48:325–33. CrossRef
- Schmidt WA. Value of sonography in diagnosis of rheumatoid arthritis. Lancet 2001;357:1056–57. CrossRef
- Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48:955–62. CrossRef
- Ribbens C, Andre B, Marcelis S, Kaye O, Mathy L, Bonnet V, et al. Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study. Radiology 2003;229:562–69.
- Boutry N, Larde A, Demondion X, Cortet B, Cotten H, Cotten A. Metacarpophalangeal joints at US in asymptomatic volunteers and cadaveric specimens. Radiology 2004;232:716–24.
- Walther M, Harms H, Krenn V, Radke S, Faehndrich TP, Gohlke F. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patient with osteoarthritis and rheumatoid arthritis. Arthritis Rheum 2001;44:331–38. CrossRef
- Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M. Power doppler ultrasonogrphy for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis. A comparison with dynamic magnetic resonance imaging. Arthritis Rheum 2001;44:2018–23. CrossRef
- Lopez-Ben R, Bernreuter WK, Moreland LW, Alarcón GS. Sonographic detection of joint erosion in rheumatoid arthritis. Scientific paper presented at the Annual Meeting of the American Roentgen Ray Society, San Diego California. AJR Am J Roentgenol 2003;180:28.
- Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: a prospective longitudinal study
Volume 36, Issue 2 , pp 123-128
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Rheumatoid arthritis
- Industry Sectors
- Author Affiliations
- 1. Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- 2. Department of Diagnostic Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
- 4. JT 360, UAB Radiology, 619 19th Street South, Birmingham, AL, 35249-6830, USA
- 3. The Biostatistics and Bioinformatics Unit, General Clinical Research Center, The University of Alabama at Birmingham, Birmingham, AL, USA