Background Imaging in early rheumatoid arthritis (RA) has undergone extraordinary change in recent years and new techniques are now available to help the clinician diagnose and manage patients much more effectively than previously. Ultrasound (US) examination could be of valuable help in the early diagnosis of RA.
Objectives The present study is designed to assess the contribution of the US in diagnosis of the very early RA (within the first 6 months of the disease onset).
Methods we conduct a cross sectional study of 36 consecutive patients with recent rheumatoid arthritis (less than 6 months of disease onset) diagnosed according to ACR-EULAR 2010 RA criteria. Patients have been clinically evaluated for pain and swelling of their hand joints, and underwent radiographs and sonography of the hand. The ultrasonography was made by the same radiologist who was unaware of clinical pattern using the same US machine (Philips HD 11) and high frequency linear probe 15 MHz.
Results 28 women and 8 men were included. Their mean age was 48.3±1.15years (range: 16-74) and mean disease duration was 4.3±2.4 months (range 2-6 months). The disease have been active in all cases: mean DAS28 4.39±2.46. the mean tender joint count was 12. The mean swollen joint count was 5. The Rheumatoid factor was positive in 44.4% of cases and the ACPA was positive in 30% of cases. In 30% of cases, US had a valuable contribution in establishing RA diagnosis. In fact, among patients having no synovitis on examination, US showed at least one synovitis in 12 cases. In other 12 cases, bone erosions was found only on US (not shown on radiography). Radiography showed joint narrowing in 26 cases and bone erosion in 9 cases. The Sharp score was 7.58±8.36 in average. Ultrasounds showed erosion in 16 cases, joint synovitis in 29 cases, joint effusion in 18 cases and synovial hypertrophy in 24 cases with power doppler in 20 cases.
Conclusions US is an accurate tool for the assessment of joint inflammation and bone erosion in patients with very early rheumatoid arthritis (RA).
Disclosure of Interest None declared