European Radiology

, Volume 25, Issue 9, pp 2688–2692 | Cite as

Ultrasound evaluation of joints in systemic lupus erythematosus: a systematic review

  • Carolina F. Lins
  • Mittermayer B. SantiagoEmail author



The aim of this systematic review is to describe the scientific evidence regarding sonographic findings of joints in SLE patients.


Seven databases were searched (PubMed, ScienceDirect, Scopus, Cochrane, EMBASE, LILACS, and SciELO) for articles from 1950 to January 2015. The keywords used for selecting articles include “lupus”, “ultrasound imaging”, “ultrasonography”, “synovitis”, “tenosynovitis”, and “arthritis”.


A total of 12 articles were included in the final analysis. In total, 610 SLE patients and 1,091 joints were studied. Most patients underwent bilateral joint examination by US. A total of 888 hands and wrists, 154 ankles/feet, and 56 knees were examined. Effusion was identified in 602 joints, synovitis in 213, tenosynovitis in 210, synovial hypertrophy in 150, and bone erosions in 73 cases. The majority of the studies demonstrated higher frequency of musculoskeletal abnormalities on US than those observed on physical examination.


US seems to be a valuable tool to identify subclinical joint manifestations in SLE. Prospective studies are necessary to determine if those patients with subclinical joint abnormalities have a higher risk for the development of chronic deformities as those seen in Jaccoud’s Arthropathy.

Key Points

Musculoskeletal involvement occurs in more than 90 % of SLE cases.

Arthralgia or tender/swollen joints found on physical examination showed more US findings.

Patients without joint symptoms or physical examinations changes showed musculoskeletal sonographic findings.

US became a useful tool for rheumatologists.

A substantial number of asymptomatic patients show abnormalities at musculoskeletal US.


Ultrasound Systemic lupus erythematosus Systematic review Joints Synovitis 



The scientific guarantor of this publication is Mittermayer Barreto Santiago M.D., PhD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was not required because the article is a systematic review.

M.S. received a scholarship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).


  1. 1.
    Messuti L, Zoli A, Gremese E, Ferraccioli G (2014) Joint involvement in SLE: the controversy of RHUPUS. Int Trends Immun 2(4):155–161Google Scholar
  2. 2.
    Santiago MB, Galvao V (2008) Jaccoud arthropathy in systemic lupus erythematosus: analysis of clinical characteristics and review of the literature. Medicine (Baltimore) 87(1):37–44CrossRefGoogle Scholar
  3. 3.
    Demirkaya E, Ozcakar L, Turker T et al (2009) Musculoskeletal sonography in juvenile systemic lupus erythematosus. Arthritis Rheum 61(1):58–60PubMedCrossRefGoogle Scholar
  4. 4.
    Grossman JM (2009) Lupus arthritis. Best Pract Res Clin Rheumatol 23(4):495–506PubMedCrossRefGoogle Scholar
  5. 5.
    Ball EM, Bell AL (2012) Lupus arthritis–do we have a clinically useful classification? Rheumatology 51(5):771–779PubMedCrossRefGoogle Scholar
  6. 6.
    Kaya A, Kara M, Tiftik T et al (2013) Ultrasonographic evaluation of the femoral cartilage thickness in patients with systemic lupus erythematosus. Rheumatol Int 33(4):899–901PubMedCrossRefGoogle Scholar
  7. 7.
    Kaya A, Kara M, Tiftik T (2013) Ultrasonographic evaluation of the muscle architecture in patients with systemic lupus erythematosus. Clin Rheumatol 32(8):1155–1160PubMedCrossRefGoogle Scholar
  8. 8.
    Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151(4):W65–W94PubMedCrossRefGoogle Scholar
  9. 9.
    Dreyer L, Jacobsen S, Juul L, Terslev L (2014) Ultrasonographic abnormalities and inter-reader reliability in Danish patients with systemic lupus erythematosus - a comparison with clinical examination of wrist and metacarpophalangeal joints. Lupus. doi: 10.1177/0961203314561666 PubMedGoogle Scholar
  10. 10.
    Yoon HS, Kim KJ, Baek IW et al (2014) Ultrasonography is useful to detect subclinical synovitis in SLE patients without musculoskeletal involvement before symptoms appear. Clin Rheumatol 33(3):341–348PubMedCrossRefGoogle Scholar
  11. 11.
    Iagnocco A, Ceccarelli F, Rizzo C et al (2014) Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus. Rheumatology 53(3):465–472PubMedCrossRefGoogle Scholar
  12. 12.
    Gabba A, Piga M, Vacca A et al (2012) Joint and tendon involvement in systemic lupus erythematosus: an ultrasound study of hands and wrists in 108 patients. Rheumatology 51(12):2278–2285PubMedCrossRefGoogle Scholar
  13. 13.
    Torrente-Segarra V, Lisbona MP, Rotes-Sala D et al (2013) Hand and wrist arthralgia in systemic lupus erythematosus is associated to ultrasonographic abnormalities. Joint Bone Spine 80(4):402–406PubMedCrossRefGoogle Scholar
  14. 14.
    Iagnocco A, Ossandon A, Coari G et al (2004) Wrist joint involvement in systemic lupus erythematosus. An ultrasonographic study. Clin Exp Rheumatol 22(5):621–624PubMedGoogle Scholar
  15. 15.
    Ossandon A, Iagnocco A, Alessandri C, Priori R, Conti F, Valesini G (2009) Ultrasonographic depiction of knee joint alterations in systemic lupus erythematosus. Clin Exp Rheumatol 27(2):329–332PubMedGoogle Scholar
  16. 16.
    Delle Sedie A, Riente L, Scire CA et al (2009) Ultrasound imaging for the rheumatologist. XXIV. Sonographic evaluation of wrist and hand joint and tendon involvement in systemic lupus erythematosus. Clin Exp Rheumatol 27(6):897–901PubMedGoogle Scholar
  17. 17.
    Mosca M, Tani C, Carli L et al (2015) The role of imaging in the evaluation of joint involvement in 102 consecutive patients with systemic lupus erythematosus. Autoimmun Rev 14(1):10–15PubMedCrossRefGoogle Scholar
  18. 18.
    Wright S, Filippucci E, Grassi W, Grey A, Bell A (2006) Hand arthritis in systemic lupus erythematosus: an ultrasound pictorial essay. Lupus 15(8):501–506PubMedCrossRefGoogle Scholar
  19. 19.
    Ball EM, Gibson DS, Bell AL, Rooney MR (2014) Plasma IL-6 levels correlate with clinical and ultrasound measures of arthritis in patients with systemic lupus erythematosus. Lupus 23(1):46–56PubMedCrossRefGoogle Scholar
  20. 20.
    Grassi W, Filippucci E, Farina A, Cervini C (2000) Sonographic imaging of tendons. Arthritis Rheum 43(5):969–976PubMedCrossRefGoogle Scholar
  21. 21.
    Grassi W, Lamanna G, Farina A, Cervini C (1999) Synovitis of small joints: sonographic guided diagnostic and therapeutic approach. Ann Rheum Dis 58(10):595–597PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  1. 1.Escola Bahiana de Medicina e Saúde PúblicaSalvadorBrazil
  2. 2.Serviços Especializados em Reumatologia da BahiaSalvadorBrazil

Personalised recommendations