Ultrasonographic Assessment of Early Bone Erosions in Addition to Soft-Tissue Changes in Rheumatoid Arthritis

Abstract

A 55-year old male presented to the outpatient clinic with painful swelling and morning stiffness in both wrists and finger joints which had started 6 weeks ago. The morning stiffness in both hands and wrists lasted for up to 2 hours and improved with activity. Detailed questioning revealed no significant past medical history. On physical examination, there was deformity and swelling on the wrists and hands. Soft-tender swellings were determined in the metacarpophalangeal (MCP) and proximal interphalangeal joints of the second through fifth digits of both hands. The serum C-reactive protein (CRP) level, anti-CRP level and erythrocyte sedimentation rates (ESR) were increased (CRP=68 mg/L; ESR=87 mm/h; anti-CRP=364 UI/ mL). Rheumatoid factor levels were within the normal ranges. The leukocyte count, hepatitis markers, anti-nuclear antibodies, anti-dsDNA were also normal. Antero-posterior hand and wrist radiographs showed soft tissue swelling without erosion ( Figure 1a). Longitudinal ( Figure 1b) and axial ( Figure 1c) ultrasound (US) images showed effusion, and cortical bone erosion on the radial side of the 2 nd MCP joint (arrow).