Background Early rheumatoid arthritis (ERA) is characterized by proliferation of synovial membrane resulting in bone destruction and, consequently, if not treated, in irreversible joint damage. Ultrasonography (US) allows for an accurate and non-invasive multisite assessment of joint involvement in patients with rheumatoid arthritis (RA).
Objectives The main objective of this study was to determine both the sonographic prevalence and distribution of bone erosions in patients with ERA.
Methods Thirty patients with the diagnosis of ERA according to the new 2010 ACR/EULAR criteria (1) and 80 patients with established RA, were consecutively recruited. Thirty patients with psoriatic arthritis, 15 with primary osteoarthritis and 10 with gout were included as disease controls, and 15 subjects without history of joint disease were recruited as healthy controls. The presence of bone erosions was investigated by US at the following anatomic sites: the second and the fifth metacarpal heads of both hands, the ulnar head bilaterally and the first and fifth metatarsal heads of both feet. The US examinations were performed using a MyLabTwice (Esaote SpA, Genoa, Italy), equipped with a broadband 6-18 MHz linear probe. Dorsal, volar and lateral aspects were explored in both longitudinal and transverse views.
Results At least one US bone erosion was found in a total of 20 (67%) out of 30 patients with ERA. In 10 (33%) of them the erosion was found on the fifth metatarsal head. Bone erosions were most frequently found on the lateral quadrants of all the scanned anatomic sites in both ERA and RA. In patients with ERA and US erosive disease, unifocal, multifocal, and massive erosions were found in 20 (100%), 2 (12%), and none patients, respectively. Bilateral US assessment of both the second and fifth metacarpal heads, and fifth metatarsal head revealed an erosive disease in 60% of ERA patients. The first metatarsal head was more frequently involved in the disease control group than in patients with ERA and RA.
Conclusions This study found a quite high number of ERA patients with US bone erosions, the fifth metatarsal head and the lateral aspects being the most frequently involved site and quadrants. US scanning for bone erosions on few target joints was found feasible and provided information not obtainable with clinical examination. Thus, its use should be encouraged in the clinical setting of early arthritis clinics.
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69:1580-8.
Disclosure of Interest None Declared