Abstract
Rheumatoid arthritis (RA) is the archetypal inflammatory arthritis. Inflammatory changes detectable by ultrasound (US) in RA include synovial effusion, synovial hypertrophy and increased vascularization. The main structural changes are bone erosions, cartilage damage and tendon tears. Joint cavity widening is the key US finding indicative of synovitis and may depend on a variable amount of synovial fluid and synovial proliferation. Synovial effusion is virtually the first step of the inflammatory process detectable by US; however, to date, synovial effusion alone is not enough to be indicative of synovitis in RA. Synovial hypertrophy is the mandatory US abnormality for the definition of synovitis even in the absence of Doppler findings.
Bone erosions and cartilage damage are the main structural changes at joint level. A number of scoring systems have been proposed to estimate the size of bone erosions especially at hand and feet level. The initial US abnormality indicative of cartilage damage is the loss of the sharpness of the chondrosynovial margin. In advanced stages, partial or complete thinning of the cartilage layer and subchondral bone erosion can occur.
At tendon level, US can identify US findings indicative of both synovial inflammation and structural damage. Tendon sheath widening is the hallmark of tenosynovitis in RA. The range of tendon tears in RA is wide and includes loss of “fibrillar” echotexture in the initial stages and partial and complete tendon rupture in long-standing disease.
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Bruyn GAW, Hanova P, Iagnocco A, D’Agostino MA, Möller I, Terslev L, et al. Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability. Ann Rheum Dis. 2014;73:1929–34.
Cipolletta E, Hurnakova J, Di Matteo A, et al. Prevalence and distribution of cartilage and bone damage at metacarpal head in healthy subjects. Clin Exp Rheumatol. 2021;39(6):1394–401.
Cipolletta E, Mandl P, Di Matteo A, et al. Sonographic assessment of cartilage damage at the metacarpal head in rheumatoid arthritis: qualitative versus quantitative methods. Rheumatology (Oxford). 2022;61(3):1018–25. https://doi.org/10.1093/rheumatology/keab472.
Cipolletta E, Filippucci E, Di Matteo A, et al. The reliability of ultrasound in the assessment of hyaline cartilage in rheumatoid arthritis and healthy metacarpal heads [published online ahead of print, 2020 Oct 30]. Ultraschall Med. 2020. https://doi.org/10.1055/a-1285-4602.
D’Agostino MA, Terslev L, Wakefield R, Østergaard M, Balint P, Naredo E, et al. Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: From diagnosis to remission. Ann Rheum Dis. 2016;75:1902–8.
Døhn UM, Ejbjerg BJ, Court-Payen M, Hasselquist M, Narvestad E, Szkudlarek M, et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther. 2006;8:R110. https://doi.org/10.1186/ar1995.
Filippou G, Sakellariou G, Scirè CA, Carrara G, Rumi F, Bellis E, et al. The predictive role of ultrasound-detected tenosynovitis and joint synovitis for flare in patients with rheumatoid arthritis in stable remission. Results of an Italian multicentre study of the Italian Society for Rheumatology Group for Ultrasound: The STARTER study. Ann Rheum Dis. 2018;77:1283–9.
Filippucci E, Iagnocco A, Meenagh G, Riente L, Delle Sedie A, Bombardieri S, et al. Ultrasound imaging for the rheumatologist VII. Ultrasound imaging in rheumatoid arthritis. Clin Exp Rheumatol. 2007;25:5–10.
Filippucci E, Cipolletta E, Mashadi Mirza R, Carotti M, Giovagnoni A, Salaffi F, et al. Ultrasound imaging in rheumatoid arthritis. Radiol Med. 2019;124:1087–100.
Finzel S, Ohrndorf S, Englbrecht M, Stach C, Messerschmidt J, Schett G, et al. A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum. 2011;63:1231–6.
Han J, Geng Y, Deng X, Zhang Z. Subclinical synovitis assessed by ultrasound predicts flare and progressive bone erosion in rheumatoid arthritis patients with clinical remission: A systematic review and meta-analysis. J Rheumatol. 2016;43:2010–8.
Koski JM, Saarakkala S, Helle M, Hakulinen U, Heikkinen JO, Hermunen H. Power Doppler ultrasonography and synovitis: Correlating ultrasound imaging with histopathological findings and evaluating the performance of ultrasound equipments. Ann Rheum Dis. 2006;65:1590–5.
Jindal S, Kaushik R, Raghuvanshi S, Kaushik RM, Kakkar R. Gray scale and power doppler ultrasonographic findings in the assessment of disease activity and their correlation with disease activity parameters in rheumatoid arthritis. Curr Rheumatol Rev. 2017;14:153–62.
Mandl P, Studenic P, Filippucci E, Bachta A, Backhaus M, Bong D, et al. Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis. Rheumatology (United Kingdom). 2019;58:1802–11.
Naredo E, D’Agostino MA, Wakefield RJ, Möller I, Balint PV, Filippucci E, et al. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis. 2013;72:1328–34.
Szkudlarek M, Klarlund M, Narvestad E, Court-Payen M, Strandberg C, Jensen KE, et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther. 2006;8:R52. https://doi.org/10.1186/ar1904.
Szkudlarek M, Terslev L, Wakefield RJ, Backhaus M, Balint PV, Bruyn GAW, et al. Summary findings of a systematic literature review of the ultrasound assessment of bone erosions in rheumatoid arthritis. J Rheumatol. 2016;43:12–21.
Tămaş M-M, Filippucci E, Becciolini A, Gutierrez M, Di Geso L, Bonfiglioli K, et al. Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease. Rheumatology (Oxford). 2014;53:1100–7.
Terslev L, Østergaard M, Sexton J, Hammer HB. Is synovial hypertrophy without Doppler activity sensitive to change? Post-hoc analysis from a rheumatoid arthritis ultrasound study 11 Medical and Health Sciences 1103 Clinical Sciences. Arthritis Res Ther. 2018;20 https://doi.org/10.1186/s13075-018-1709-6.
Vreju FA, Filippucci E, Gutierrez M, Di Geso L, Ciapetti A, Ciurea ME, et al. Subclinical ultrasound synovitis in a particular joint is associated with ultrasound evidence of bone erosions in that same joint in rheumatoid patients in clinical remission. Clin Exp Rheumatol. 2016;34:673–8.
Zayat AS, Ellegaard K, Conaghan PG, Terslev L, Hensor EMA, Freeston JE, et al. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis. 2015;74:897–903.
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Carotti, M., Filippucci, E., Salaffi, F., Martino, F. (2022). Rheumatoid Arthritis. In: Martino, F., Silvestri, E., Orlandi, D. (eds) Musculoskeletal Ultrasound in Orthopedic and Rheumatic disease in Adults. Springer, Cham. https://doi.org/10.1007/978-3-030-91202-4_8
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DOI: https://doi.org/10.1007/978-3-030-91202-4_8
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