Background In the treatment of rheumatoid arthritis (RA), early diagnosis and tight control increased their importance in the era of biological 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 objectives of this study were to investigate whether the image of ultrasonography (US) at the operated joint reflects synovial pathology or clinical indicators, and to compare the results in the large joints (LJs) with those in the small joints (SJs).
Methods Orthopaedic surgery was performed on 170 joints in 149 patients with RA. There were 48 LJs including 2 shoulders, 24 elbows and 22 knees, and 122 SJs including 59 wrists, 39 fingers, 7 ankles and 17 toes. Preoperatively, US was performed and grade of Power Doppler (PD) signal was evaluated. 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 synovial 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.
At the operation, synovial tissue was collected from the part, in which PD signal was highest. Rooney score represents the histological 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. Each item was scored on a scale of 1 to10 depending on its severity.
Results In LJs, 33 joints were in grade 0 or 1 in PD signal (group L), and 15 were in grade 2 or 3 (group H). In SJs, 69 joints were in group L and 53 were in group H. Totally, DAS28-ESR(4), CRP, MMP-3 and Rooney score in group H were significantly higher than those in group L. In comparison between group L and group H, difference in DAS28-ESR(4), MMP-3 and CRP in LJs was more than that in SJs. Whereas, difference in Rooney score in LJs was less than that in SJs.
Conclusions PD signal in the image of US reflects synovial pathology and clinical indicators. It reflects systemic inflammation well in LJs and regional distinctive feature of synovitis in SJs.,
References 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