Background The early diagnosis of RA is often difficult in the absence of immunologic markers, bone erosions on radiographs or clinical characteristic features such as typical joint involvement or rheumatoid nodules.

Objectives The aim of this study was to assess the contribution of High resolution Doppler Ultrasound in the early diagnosis of RA with negative immunologic markers.

Methods Cross sectional study of 44 patients admitted in our institution between 2009 and 2011. Inclusion criteria were the following: recent onset inflammatory rheumatism (<2 years), negative immunological markers, absence of bone erosion or joint narrowing on radiographs of both hands. All patients had High resolution Doppler ultrasound of both hands using a 15 Mhz linear probe to assess synovitis, tenosynovitis, bone erosion and Doppler hyperhemia.

Results Thirty four women and ten men fulfilled the inclusion criteria. The mean age was 53±13 [18-76] years. The onset of symptoms was mono-articular in 54.5%, oligo-articular in 11.3% and polyarticular in 34.2% of cases. The mean duration of the disease was 11.2±7.6 [2-24] months. Radiographs showed epiphyseal bone demineralization in 12 cases. Ultrasound showed at least one synovitis in 39 patients, 17 of which associated with Doppler hyperhemia. More than 5 joints were involved in 32 patients and bone erosions were detected in 19 cases. High resolution ultrasound allowed confirmation of early RA in 43.1% of cases since it showed bone erosions in 19 patients with inflammatory rheumatism, elsewhere ultrasound has helped the diagnosis of early inflammatory rheumatism since it showed polysynovitis in 14 of 24 patients showing a mono-articular clinical involvement.

Conclusions High resolution Doppler ultrasound is more sensitive than Radiographs in detecting bone erosions, synovitis and hyperhemia. Combined with a meticulous clinical examination, US is useful in the early diagnosis of RA.

Disclosure of Interest None Declared