The importance of ultrasound examination in early arthritis

Abstract

ObjectivesTo assess the importance of ultrasound (US) examination of joints in hands and feet in patients with early arthritis and perform comparative analysis of the diagnostic value of US examination for 8, 12 and 52 selected joints.Material and methods123 patients (87 women, 36 men) with arthritis lasting less than 12 months, naive to disease-modifying anti-rheumatic drugs and glucocorticosteroids. Necessary differential diagnostics was performed for each patient. After the preliminary analysis, 72 patients met the classification criteria for rheumatoid arthritis (RA) according to ACR/EULAR of 2010, and undifferentiated arthritis (UA) was diagnosed in 51 patients. UA patients were followed up after 6 and 12 months, and verification of the initial diagnosis yielded the following groups of patients: patients meeting classification criteria for RA, patients with maintained diagnosis of UA, patients in remission, and patients with other diagnoses. Ultrasound examination was performed considering the volume of joint effusion (JE), synovial membrane hypertrophy (GS), and synovial membrane hyperaemia assessed by power Doppler (PD). Results were assessed using the semi-qualitative scale. Coefficients being the sum of US scores for the assessment of JE, GS and PD for 52 and 12 joints in hands and feet, and 8 joints in hands were determined for the purpose of the study.ResultsIn patients meeting classification criteria for RA during the initial assessment the US examination yielded significantly higher PD-52I, PD-12I and PD-8I coefficients. In UA patients who were diagnosed with RA after 12 months, the GS-8I coefficient was significantly higher.ConclusionsUltrasonography is a valuable tool in diagnostics of early arthritis. The GS assessment has prognostic value for UA patients. The assessment of 8 or 12 selected joints is often sufficient for the diagnostics of patients with early arthritis.

A Pragmatic Application of Ultrasonography for the Assessment of Disease Activity in Patients with Early Inflammatory Arthritis

“…The Sum of PD grade correlated better with serum inflammatory markers (ESR and CRP) and assessments of patient global health (VAS-GH). All three previous studies that evaluated the correlations between MSUS parameters and clinical disease activity markers have shown that the sums of the PDUS or GSUS semi-quantitative grades correlated well with DAS28 in patients with established RA [ 33 , 42 , 43 ] and patients with EIA [ 19 ]. However, the sums of the GSUS grades did not exhibit significant correlations with DAS28, unlike the sums of the PDUS grades, in a study of 50 RA patients reported by El-Gohary et al [ 33 ].…”

“…To date, there have been many clinical studies using MSUS in assessing disease activity in patients with established RA [ 17 ]. MSUS studies scarcely evaluated disease activity in patients with early RA or UA that physicians could easily encounter in daily clinical practice [ 18 , 19 , 20 ]. Therefore, we focused on measuring the activity of synovitis in patients with EIA applying a pragmatic MSUS approach by limiting target joints only to those with arthritic signs.…”

Color fraction as a useful method of imaging synovium vascularization in patients with high activity of rheumatoid arthritis

“…Using the joint effusion index (JEI), synovial hypertrophy index (GSI) and power Doppler index (PDI) including 8 or 12 or 52 joints it is possible to predict occurrence of RA or remission of inflammation. The GSI assessment has especially prognostic value for UA patients [24].…”

“…Ultrasonography (US) versus magnetic resonance imaging (MRI) in joint evaluation in rheumatoid arthritis[24,25] InTable I the advantages and disadvantages of US vs MRI are presented.…”

The changing role of ultrasonography examination in patients with rheumatoid arthritis in light of recent studies

“…Ultrasound offers a clear advantage in assessing subclinical synovitis, which is important for the evaluation of radiographic progression risk and for the identification of patients who can maintain remission despite dose reduction [ 1 , 41 , 42 ]. Moreover, in ERA diagnosis, US allows for early detection of the disease and should be included in future classification criteria [ 43 – 45 ]. The application of a US is shown in Table I .…”