The initial ultrasonographic examination of hands and feet joints in patients with early rheumatoid arthritis

Abstract

Objectives: The aim was to assess of the morphology, intensity, and activity of changes in the first ultrasonographic (US) examination of hands and feet in patients with early arthritis (lasting up to 12 months) who were ultimately diagnosed with rheumatoid arthritis (RA). An attempt was made to demonstrate a correlation between the intensity of lesions in US and selected laboratory parameters. Material and methods: Ultrasonographic examination was performed using a LOGIC GE 500 device on a group of 60 patients with arthritis (46 women, 14 men) aged 18-80, previously untreated. In total, 3120 hand and feet joints were examined. The assessment focused on the presence of joint effusion, synovial proliferation and power Doppler signals (assessed on a semi-quantitative scale). Each patient underwent laboratory tests, necessary for making a diagnosis. In order to analyze the correlations between changes in US and laboratory parameters, erythrocyte sedimentation rate (ESR), reactive protein test (CRP), rheumatoid factor (RF), and anti-citrullinated protein antibodies (ACPAs) were used. Results: In the study group, the average duration of arthritis symptoms until the first US examination was 5.6 months. Among the 3120 examined hand and foot joints, deviations from the norm appeared in 1093 joints, synovial hypertrophy was found in 471 joints (grade 1 synovial hypertrophy was reported most frequently), while presence of signal in Power Doppler was revealed in 261 joints (grade 1 was observed most frequently). A statistically significant correlation was found between the intensity of changes in Power Doppler and CRP concentration. Conclusions: In patients with increased concentrations of CRP, we may expect arthritis of higher intensity, therefore, in order to prevent the progression of destructive changes, it is necessary to quickly implement effective disease-modifying antirheumatic treatment. The conducted research showed that the activity of joint inflammation is not affected by the values of ESR and the presence of RF or ACPAs.

The importance of ultrasound examination in early arthritis

“…The reason may be a rather low mean CRP value in this group of patients. In our previous study we demonstrated that higher CRP values were correlated with higher values of the PD index [15].…”