Background In the treatment of rheumatoid arthritis (RA), early diagnosis and tight control increased their importance in the era of biologic therapy. Ultrasonography (US) of the various joints enables an evaluation of synovits and bone erosion in real time. It is proved to be useful to detect synovitis in the early stage of the disease.
Objectives The objective of this study is to investigate whether power doppler (PD) signal in the image of US at the operated joint reflects synovium pathology or clinical data.
Methods Orthopaedic surgery was performed on 38 joints in 37 patients with RA. Preoperatively, US was performed and grade of PD signal was determined at the part with the highest signal. PD signal consists 4 grades from grade 0 to 3. Grade 0 is no signal, grade 1 is just dot signal, grade 2 is the signal agglutinated but the signal positive area is below a half of whole hypertrophic synovium, grade 3 is the signal agglutinated but the signal positive area is over a half of whole hypertrophic synovium. Rooney score of synovium pathology, Larsen grade at the operated joint, disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR) 4, matrix metalloproteinase (MMP)-3, C reactive protein (CRP) were investigated. The site of operation was one shoulder, one knees, 9 elbows, 18 wrists and 8 fingers. At the operation, synovial tissue was obtained from the part, in which PD signal was highest. Rooney score represents the histologic features in the synovium of RA. It includes 6 features i.e. synoviocytes hyperplasia, fibrosis, proliferating blood vessels, perivascular infiltrates of lymphocytes, focal aggregates of lymphocytes, diffuse infiltrates of lymphocytes. They were scored separately on a scale of 1-10.
Results In PD signal, 16 joints were in grade 0 or 1 (group L) and 22 joints were in grade 2 or 3 (group H). CRP in group L (0.28±0.48: mean±SD) was significantly lower than that in group H (1.46±2.13, p=0.019). Larsen grade, DAS28-ESR4 and MMP-3 were not associated with grade of PD signal. Total Rooney score in group L (25.8±10.5) was significantly lower than that in group H (37.5±6.9, p<0.001). In group L, synoviocytes hyperplasia (1.56±1.51), perivascular infiltrates of lymphocytes (3.44±3.79), focal aggregates of lymphocytes (2.13±2.19), and diffuse infiltrates of lymphocytes (3.44±3.50) were significantly lower than those in group H (3.05±1.86, p=0.010, 7.50±2.65, p=0.001, 4.91±2.54, p=0.001, 7.14±2.90, p=0.002). However, there were no significant difference between fibrosis in group L (9.38±1.75) and that in group H (8.00±3.21, p=0.06), and between proliferating blood vessels in group L (6.00±2.25) and that in group H (7.09±2.00, p=0.13). This meant that a high number of moving red blood cells in the synovial tissue was not directly associated with highly proliferated blood vessels.
Conclusions PD signal in the image of US was one of the indicators to reflect CRP and synovium pathology.
Walther M, Harms H, Krenn V, et al. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthrits Rheum 2001;44:331-8.
Disclosure of Interest None Declared