Ultrasonography is useful to detect subclinical synovitis in SLE patients without musculoskeletal involvement before symptoms appear

Yoon, Hyuck–Jun; Kim, Ki-Jo; Baek, In‐Cheol; Joo, Young Bin; Kim, Wan‐Uk; Yoon, Chong‐Hyeon; Cho, Chul-Soo

doi:10.1007/s10067-014-2502-9

Cited by 37 publications

(50 citation statements)

References 27 publications

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“…Compared with the study of Yoon et al,14 our study detected a higher prevalence of SH (grade≥1) in asymptomatic patients with SLE. While the previous study identified joint effusion and/or SH in 58% of asymptomatic patients with SLE, we detected SH (grade ≥1) in 77% asymptomatic patients with SLE.…”

Section: Discussioncontrasting

confidence: 91%

“…While a number of studies have recently described US findings in the SLE population, only some of these included patients who did not complain of musculoskeletal symptoms at the time of the US evaluation,5 35–39 and, to our knowledge, only one focused on asymptomatic patients 14. In these studies, the prevalence of US abnormalities in asymptomatic patients with SLE varied from 3% to 58% 5…”

Section: Discussionmentioning

confidence: 99%

“…SH index and PD index were calculated using the Szkudlarek grading method,14 34 and the Global OMERACT–EULAR Synovitis Score (GLOESS) was calculated using the composite PDUS synovitis score 31…”

Section: Methodsmentioning

confidence: 99%

“…Based on data from Yoon et al (subclinical synovitis detected in 58.3% of asymptomatic patients with SLE and 5.6% of controls),14 for a 0.05 α-value and 90% power, and considering a 3:1 ratio, a sample size of 30 asymptomatic patients with SLE and 10 controls was calculated.…”

Section: Methodsmentioning

confidence: 99%

“…14 Furthermore, while it is known that minimal synovial proliferation may be seen in up to 50% of healthy subjects, the distinction between ‘normal’ synovial hypertrophy (SH) and pathological subclinical synovitis in SLE still requires clarification 15–18…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound detects subclinical joint inflammation in the hands and wrists of patients with systemic lupus erythematosus without musculoskeletal symptoms

et al. 2017

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ObjectivesTo assess the prevalence and severity of ultrasonographic abnormalities of the hand and wrist of asymptomatic patients with systemic lupus erythematosus (SLE) and compare these findings with those from patients with SLE with musculoskeletal signs or symptoms and healthy controls.MethodsWe conducted a prospective cross-sectional study that evaluated bilaterally, with grey-scale and power Doppler (PD) ultrasound (US), the dorsal hand (2nd to 5th metacarpophalangeal and 2nd to 5th proximal interphalangeal joints) and wrist (radiocarpal, ulnocarpal and intercarpal joints) of 30 asymptomatic patients with SLE, 6 symptomatic patients with SLE and 10 controls. Synovial hypertrophy (SH) and intra-articular PD signal were scored using semiquantitative grading scales (0–3). Individual scores were graded as normal (SH≤1 and PD=0) or abnormal (SH≥2 or PD≥1). Global indexes for SH and PD were also calculated. US findings were correlated with clinical and laboratory data and disease activity indexes.ResultsUS detected SH (score ≥1) in 77% asymptomatic patients with SLE, mostly graded as minimal (score 1: 63%). 23% of the asymptomatic patients with SLE showed abnormal US PD findings (SH≥2 or PD≥1). SH was present in all symptomatic patients with SLE, mostly graded as moderate (grade 2: 67%), and with associated PD signal (83%). SH (score 1) was identified in 50% of controls, however, none presented abnormal US PD findings. SH index in the asymptomatic SLE group was higher than in the control group (2.0 (0–5) vs 0.5 (0–2), median (range), p=0.01) and lower than in the symptomatic SLE group (7.0 (4–23), median (range), p<0.001). No significant correlation was demonstrated between US PD findings and clinical or laboratory variables and disease activity indexes.ConclusionA small subgroup of asymptomatic patients with SLE may present subclinical joint inflammation. Global US scores and PD signal may be important in disease evaluation and therapeutic monitoring.

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasound detects subclinical joint inflammation in the hands and wrists of patients with systemic lupus erythematosus without musculoskeletal symptoms

et al. 2017

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Optimal Elbow Positions for Identification of the Radial Collateral Ligament Using Ultrasonography

Park

Kim

Lee

et al. 2019

PM&R

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BackgroundThe standard position for examining the lateral elbow with ultrasonography is an “extended” or “slightly flexed” position. However, because the radial collateral ligament (RCL) is more deeply attached on the lateral epicondyle than the common extensor tendon, an anisotropic artifact of the RCL could be observed in the conventional positions, making it difficult to fully visualize the RCL.ObjectivesTo determine optimal elbow positions for accurate identification of the RCL and to explore the relevant landmarks in ultrasonography.DesignProspective study.SettingTertiary university hospital.ParticipantsForty healthy elbows of 20 participants.MethodsThe RCL was evaluated using ultrasonography in six elbow flexion positions (0°, 30°, 60°, 90°, 120°, and 140°). The relative depth, defined as the depth of the capitellum subtracted by the depth of the radial head under ultrasonography, was measured at each angle. The rates of successful identification of ultrasonographic landmarks for localizing the RCL were calculated. After ultrasonography, the optimal elbow position for identifying the RCL was determined by group consensus.Main Outcome MeasurementsRelative depth between radial head and capitellum, rates of successful identification of ultrasonographic landmarks, and consensus‐based determination of the optimal angle.ResultsThe relative depth significantly decreased with an increase in the flexion angle (P for trend <.001), approaching zero at the angles of 90° and 120°. The rates of successful identification of the superior tubercle, hyperechogenic line, and anterior and posterior tubercles were 100%, 100%, 90%, and 80%, respectively. In the group consensus, the 90° and 120° flexion angles were selected with the highest frequency (90%; 36/40).ConclusionOur findings suggest that elbow flexion at 90° or 120° is optimal for visualization of the RCL with the least possibility of anisotropy under ultrasonography, suggesting that the elbow should be flexed considerably beyond the conventional extended or slightly flexed position.

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Ultrasound in Systemic Sclerosis and Systemic Lupus Erythematosus

Fairchild

Mar

2021

Musculoskeletal Ultrasound in Rheumatology Review

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Ultrasonography is useful to detect subclinical synovitis in SLE patients without musculoskeletal involvement before symptoms appear

Cited by 37 publications

References 27 publications

Ultrasound detects subclinical joint inflammation in the hands and wrists of patients with systemic lupus erythematosus without musculoskeletal symptoms

Ultrasound detects subclinical joint inflammation in the hands and wrists of patients with systemic lupus erythematosus without musculoskeletal symptoms

Optimal Elbow Positions for Identification of the Radial Collateral Ligament Using Ultrasonography

Ultrasound in Systemic Sclerosis and Systemic Lupus Erythematosus

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