Comparison of ultrasonographic joint and tendon findings in hands between early, treatment-naïve patients with systemic lupus erythematosus and rheumatoid arthritis

Abstract

Although both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) may lead to joint deformity, SLE arthritis is typically non-erosive and often accompanied by Jaccoud's deformity. Therefore, we examined characteristics of joint and tendon lesions in patients with SLE and RA by ultrasonography. Fifteen treatment-naïve SLE patients and 40 treatment-naïve RA patients with joint symptoms were included in this study. The hand joints and related tendons were ultrasonographically examined using grey-scale (GS) and power Doppler (PD). Joint involvement was comparably observed in patients with SLE and RA (80% versus 95%, p = 0.119). However, tendon involvement was more frequent in SLE than in RA (93% versus 65%, p = 0.045), especially in the wrist joints (73% versus 40%, p = 0.037). When we investigated the intensity of US findings, the joint synovitis score (GS + PD) per affected joint was lower in SLE than RA (2.0 versus 2.6, p = 0.019), while tendon inflammation score was not significantly different (2.1 versus 2.2, p = 0.738). Finally, the examination of concordance between joint and tendon involvement in the same finger revealed that joint lesion appeared in only 49% of fingers having tendon involvement in the SLE group, which was significantly less than 74% in the RA group ( p = 0.010). Thus, as compared with RA, SLE arthropathy is characterized by the predominance of tenosynovitis/periextensor tendon inflammation, which is likely to develop independently from joint synovitis.

Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever

“…In this same study, patients with RA showed an impairment pattern similar to that of SLE, but with lower prevalence of finger flexor tenosynovitis. Both in SLE and RA, synovitis was predominant in the wrist, unlike in our study of CHIKF, in which the metacarpophalangeal joints were the most impaired …”

“…This finding is similar to some studies, but very different from those found in other series . The predominance of CHIKF in females is also seen in other rheumatological diseases, such as lupus and RA . Also noteworthy is the potential for chronification of the lesions present in our series, given that at least two risk factors cited in the literature (age greater than 45 and female gender) were present in our patients; the third factor, the presence of pre‐existing rheumatological conditions, was standardized as an exclusion criterion in our study …”

“…9,38,39 The predominance of CHIKF in females is also seen in other rheumatological diseases, such as lupus and RA. 40,41 Also noteworthy is the potential for chronification of the lesions present in our series, given that at least two risk factors cited in the literature (age greater than 45 and female gender) were present in our patients; the third factor, the presence of pre-existing rheumatological conditions, was standardized as an exclusion criterion in our study. 15,16 All of the reported symptoms have been described in the literature as being associated with arboviral infection, especially chronic joint pain, in the case of CHIKF.…”

“…Compared with other studies of rheumatological diseases, our CHIKF series closely resembles the profile of hand/wrist impairment found in systemic lupus erythematosus (SLE). 40 In a group of patients with early stage untreated SLE, Ogura et al 40 found wrist and metacarpophalangeal joint synovitis in 73% of cases, and flexor and extensor tenosynovitis in 67 and 73% of patients, respectively. In this same study, patients with RA showed an impairment pattern similar to that of SLE, but with lower prevalence of finger flexor tenosynovitis.…”

“…Both in SLE and RA, synovitis was predominant in the wrist, unlike in our study of CHIKF, in which the metacarpophalangeal joints were the most impaired. 40 In the initial phase, and in comparison with RA, CHIKF shows more intense and rapid synovial impairment, but without bone erosions. Patients in our series who were in the subacute/chronic phase of the disease had more synovitis and tenosynovitis than the patients with RA evaluated by Wang et al 41 using ultrasound and MRI.…”