Diagnostic value of high‐resolution B‐mode and doppler sonography for imaging of hand and finger joints in rheumatoid arthritis

Abstract

Objective. High-resolution sonography enables a detailed assessment of intraarticular and extraarticular soft tissue abnormalities of joints affected by rheumatoid arthritis (RA). This study was undertaken to evaluate the diagnostic value of B-mode sonography and power Doppler compared with that of clinical examinations and conventional radiography.Methods. The study group comprised 47 patients (14 men, 33 women) with different grades of RA; 31 patients were rheumatoid factor (RF) positive, and 16 were RF negative. The wrists, first through fifth metacarpophalangeal joints, and second through fifth proximal interphalangeal joints of these patients were scored with ultrasound in B-mode and power Doppler application, using a standardized technique. Involvement and severity of inflammation, as well as vascularization, were scored according to a new 3-point scale. The results were correlated with benchmarks of the clinical and radiologic investigations. Clinical status and conventional radiologic status were determined according to the Disease Activity Score and the Larsen score.Results. After preliminary studies in 15 patients, 39% of 704 joints were found to be abnormal by clinical investigation. Erosions were detected by radiography and sonography in 23% and 43% of joints, respectively. Hypervascularization was observed in 34% of 704 joints by power Doppler application. There was a significant correlation (P < 0.001) between the different methods for the detection of the severity of lesions. Use of a modern, state-of-the-art power Doppler program was necessary for semiquantification, and a standardized investigation technique and scoring system provided sufficient quality measures.Conclusion. Sonography detects 20% more abnormalities than does radiography, and sonography has the potential to provide simple grading of disease activity. The rate of detection of abnormalities was slightly higher with clinical examination compared with sonography.

Summary Findings of a Systematic Literature Review of the Ultrasound Assessment of Bone Erosions in Rheumatoid Arthritis

“…The selected papers were then divided among the group members and assessed according to an agreed scoring sheet (for results of Evaluation score, see Table 1) 4,5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]…”

Ultrasonography: A valid method for assessing rheumatoid arthritis?

“…The advantages of attaining a solid scientific basis for the use of US in RA have thus led to initiatives to document the accuracy of US findings by comparisons with histopathologic and magnetic resonance imaging (MRI) findings (6)(7)(8)(9)(10)(11), as well as to develop standardized and validated methods for assessing RA joints (4,12). Several systems for assessing pathology in RA hand, wrist, and toe joints (i.e., the joints most frequently involved in RA) have been suggested (10,11,(13)(14)(15)(16)(17), with varying levels of validation to support them.…”

T Helper 17 Cells and Inducible Nitric Oxide Synthase: Good Index to Predict Renal Tissue Involvement in Systemic Lupus Erythematosus Patients

“…Synovitis, either proliferative or exudative, is the earliest change that can be ultrasonographically graded. Its quantification via grayscale ultrasound usually uses a semiquantitative scale with three levels of intensity, indicating mild, moderate or marked synovial changes 15,16 . The term of synovitis is used to indicate the presence of synovial hypertrophy with PD signal and joint effusion.…”