Background The ultrasound (US) is being increasingly applied to the analysis of RA and the actual detection of a joint inflammatory process is essential for the management and initial treatment of Rheumatoid Arthritis.
Objectives To show the main sonographic findings in a sample of the patients with early rheumatoid arthritis (RA). A second objective was to demonstrate that the use of a score of 7 joints for Synovitis (US 7 Score SYN) can achieve the same effectiveness with a simplified method.
Methods 32 patients with RA and disease duration of 13 months on average, fulfilling ACR criteria 1987 were examined by GE LOGIQ XP-linear ultrasound (US) and high frequency transducer for gray scale (GS) and power Doppler (PD) with a semi-quantitative scale (0 to 3) in the hands and feet joints, after was calculated to US 7 Score SYN of the clinically dominant hand and foot in the dorsal recess: middle carpal wrist, second and third metacarpophalangeal (MCP) and proximal interphalangeal, and second and fifth metatarsophalangeal joints. Spearman’s correlation test was used and considered significant at the 0.05, between clinical, laboratorial and imaging findings.
Results 832 examined joints, 173 (20.79%) synovitis, 22 (4.91%) tenosynovitis and 3 (1.56%) erosions; more cases of synovitis by GS in the dorsal recess 102 (73.38%) than in the palmar recess 37 (26.61%) were detected in the small joints of hands.Positive, significant correlations were found in the presence of synovitis by GS of wrist with CRP (r=0.42; p=0.0163) and GS of small toes joints with HAQ, RF and CRP (r=0,37 to 0,42; p=0.0161 to 0.0337). The PD of wrist presented a correlation with CRP (r =0.40; p=0.00337). There was a significant negative correlation of the MCP (2) (right) palmar recess with period and dose of methotrexate (r = -0.36 to -0.37; p=0.0368 to p=0.0445).Concerning the US 7 Score SYN, there was significant correlation between the GSUS 7 Score SYN with DAS28 (CRP) (r =0.38;p=0.0332) and PDUS 7 Score SYN with CRP (r =0.39;p=0.0280).
Conclusions The erosion was not very evident in this sample, perhaps by the disease is at an early stage. The dorsal recess can be an important local to detect synovitis and dominant hand US 7 Score SYN may be a practical method for assessing joint inflammation in the early RA.
Gutierrez M, Filippucci E, Ruta S, Salaffi F, Blasetti P, Geso L D, Grassi W. Inter-observer reliability of high-resolution ultrasonography in the assessment of bone erosions in patients with rheumatoid arthritis: experience of an intensive dedicated training programme. Rheumatology. 2011;50:373-80.
Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus T.M, Hartung W, et al. Evaluation of a Novel 7-Joint Ultrasound Score in Daily Rheumatologic Practice: A Pilot Project.Arthritis Rheum. 2009; 61:1194-201.
Wakefield RJ, D’Agostino MA, Iagnocco A, Filippucci E, Backaus M, Scheel AK et al. OMERACT Ultrasound group priorities. J Rheumatol. 2007;34:848–51
Disclosure of Interest None Declared