Background Ultrasonography enables to assess the progression of inflammatory joint in patients with rheumatoid arthritis (RA) and the grey-scale and Doppler mode has become an established method for the diagnosis and measurement of response to treatment as part of the follow-up of RA patients. It is quite useful to investigate expansion of synovium and vascularization in the synovium. However, the reliability and limitations of ultrasonography remain a concern.
Objectives In this study, we investigated the differences between the findings of ultrasonography in inflamed joints and histopathological investigation in RA patients.
Methods 13 RA patients (11 female, 2 men) were enrolled in the study. At the time of joint surgery, the patients had a mean age of 62±11 years and a mean disease duration was 13±7.7 years. All surgery was arthroplasty included as follows; 5 for elbow, 2 for wrist, 1 for finger and 5 for knee. Ultrasound examinations were performed before joint surgery and Power Doppler (PD) signals graded from 0 to 3 were scored semiquantitatively. Synovial tissues were extracted from these patients at the time of operation and histopathological examination was performed using hematoxylin and eosin to evaluate differences. Clinical laboratory data including C-reactive protein (CRP), matrix metalloproteinase-3 (MMP-3), and disease activity scores including a 28-joint count (DAS28), methotrexate (MTX) dose, glucocorticoid dose and use of biologics were also assessed before surgery.
Results The US preoperatively showed synovial proliferation in all patients. The PD Grade0 was 6, Grade1 was 4, and Grade2 was 3 patients. The results of histopathological examination showed inflammatory cell infiltration and vascularization in all cases of Grade1 and Grade2. However, inflammatory cell infiltration was revealed even in all 6 cases of Grade0. Moreover, vascularization was revealed even in two cases of Grade0.
Conclusions In this study, the results of PD Grade1 and 2 scored by ultrasonography were consistent with histopathological findings. However, it was also revealed that inflammatory cell infiltration and vascularization was observed even if PD showed Grade0. Although further studies are necessary, this study may suggest the possibility that subclinical inflammation are continued even if PD shows Grade0.
Analysis of the histologic variation of synovitis in rheumatoid arthritis. Rooney M, Condell D, Quinlan W, Daly L, Whelan A, Feighery C, Bresnihan B. Arthritis Rheum. 1988 Aug;31(8):956-63.
Relationship between histological findings and clinical findings in rheumatoid arthritis. Matsuno H, Yudoh K, Nakazawa F, Koizumi F.Pathol Int. 2002 Aug;52(8):527-33.
Synovial membrane immunohistology in early untreated juvenile idiopathic arthritis: differences between clinical subgroups.Finnegan S, Clarke S, Gibson D, McAllister C, Rooney M.Ann Rheum Dis. 2011 Oct;70(10):1842-50.
Disclosure of Interest None Declared