Abstract
Purpose
To determine if ultrasound (US) of selected joints in the hands and feet can detect more erosions than radiography and establish the presence of erosive disease in patients with rheumatoid arthritis (RA).
Methods
Eighty joints in ten patients with RA and 40 joints in five healthy control subjects, who were age, gender and ethnicity-matched to the patients with arthritis, were prospectively studied with radiographs and sonography. Conventional radiographs of the hands and feet were obtained. US examinations of the 2nd and 5th metacarpal-phalangeal (MCP) joints of the hands, and the 1st and 5th metatarsal-phalangeal (MTP) joints of the feet were performed. Radiographs and US exams were independently graded for the presence of erosions.
Results
None of the control subjects had erosions. US detected erosions in 17/80, and radiographs detected erosions in 6/80 joints assessed with both modalities. US detected all erosions seen by radiographs in these selected joints. Erosive disease was present in the radiographs of seven of ten RA patients. US established erosive disease in eight of ten RA patients. US determined erosive disease in two of the three patients without radiographic erosions.
Conclusions
US of the MTP and MCP joints in RA can detect erosions not seen with radiography and may be complementary to radiography in establishing the presence of erosive disease in early RA.
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References
Barthon, JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC, et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 2000; 343:1586–1593.
Molenaar THE, Boers M, van der Heijde DMFM, Alarcon GS, Bresnihan B, Cardiel M, et al. Imaging in rheumatoid arthritis: results of a group discussion. J Rheumatol 1999; 26:749–751.
Sharp JT. Assessment of radiographic abnormalities in rheumatoid arthritis: what have we accomplished and where should we go from here? J Rheumatol 1995; 22:1787–1791.
Klarlund M, Ostergaard M, Jensen KE, Madsen JL, Skjodt H, Lorenzen I. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group. Annals of the Rheumatic Diseases. 2000; 59:521–528
Wakefield RJ, Gibbon WW, Conaghan PG, O'Connor P, McDonagle 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; 43:2762–2770.
Resnick D, Niwayama G. Rheumatoid Arthritis. In: Resnick D, ed. Diagnosis of bone and joint disorders. 3rd edn. Philadelphia: W.B. Saunders, 1995: 866–970.
Alarcon GS, Lopez-Ben R, Moreland LW. High resolution ultrasound for the study of target joints in rheumatoid arthritis. Arthritis Rheum 2002; 46:1969–1970.
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31:315–324.
Sharp JT, Strand V, Leung H, Hurley F, Loew-Friedrich I, on behalf of the Leflunomide Rheumatoid Arthritis Investigators Group. Treatment with leflunomide slows radiographic progression of rheumatoid arthritis. Results from three randomized controlled trials of leflunomide in patients with active rheumatoid arthritis. Arthritis Rheum 2000; 343:495–505.
Brook A, Corbett M. Radiographic changes in early rheumatoid disease. Ann Rheum Dis 1977; 36:71.
Martel W, Hayes J, Duff I. The pattern of bone erosion in the hand and wrist in rheumatoid arthritis. Radiology 1965; 84:204–214.
Martel W. Roentgenographic features of the rheumatic diseases. In: Rodmand GP, Schumacher HR, eds. Primer on the rheumatic diseases, 8th edn. Atlanta: Arthritis Foundation, 1983:174–183.
Norgard F. Earliest roentgenological changes in polyarthritis of the rheumatoid type: rheumatoid arthritis. Radiology 1965; 85:325–329.
Moreland L, Daniel W, Alarcon GS. The value of the Norgard view in the evaluation of erosive arthritis. J Rheumatol 1990; 17:614–617.
Hartley RM, Liang MH, Weissman BN, Sosman JL, Katz R, Charlton JR. The value of conventional views and radiographic magnification in evaluating early rheumatoid arthritis. Arthritis Rheum 1984; 27:744–751.
Brewerton D. Instrumental and technical notes: a tangential radiographic projection for demonstrating involvement in the metacarpal heads in rheumatoid arthritis. Br J Radiology 1967; 40:233–234.
Buckland-Wright J, Walker S. Incidence and size of erosions in the wrist and hand of rheumatoid patients: a quantitative microfocal radiographic study. Ann Rheum Dis 1987; 46:463.
Rominger MB, Bernreuter WK, Kenney PJ, Morgan DL, Blackburn WD, Alarcon GS. MR imaging of the hands in early rheumatoid arthritis: preliminary results. RadioGraphics 1993; 13:37–46
Sugimoto H, Takeda A, Masuyama J, Furuse M. Early stage rheumatoid arthritis: diagnostic accuracy of MR imaging. Radiology 1996; 198:185–192
Lund PJ, Heikal A, Marcic MJ, Krupinski EA, Williams CS. Ultrasonographic imaging of the hand and wrist in rheumatoid arthritis. Skeletal Radiol 1995; 24:591–596.
Grassi W, Tittarelli E, Pirani O, Avaltroni D, Cervini C. Ultrasonographic examination of the metacarpo-phalangeal joints in rheumatoid arthritis. Scand J Rheumatol 1993; 22:243–247
Backhaus M, Kamradt T, Sandrock D, Loreck D, Fritz J, Wolf KJ, et al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999; 42:1232–1245.
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The authors wish to express their gratitude to Drs. Michelle Robbin and Philip Lander for their reviews of this paper.
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Lopez-Ben, R., Bernreuter, W.K., Moreland, L.W. et al. Ultrasound detection of bone erosions in rheumatoid arthritis: a comparison to routine radiographs of the hands and feet. Skeletal Radiol 33, 80–84 (2004). https://doi.org/10.1007/s00256-003-0693-2
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DOI: https://doi.org/10.1007/s00256-003-0693-2