Objectives Tendinopathy involving the extensor tendons of the wrist is frequent in patients with rheumatoid arthritis (RA) and is common reason of pain in wrist interfering with wrist joints synovitis. Aim of study was to assess, by ultrasonography (US), the frequency of extensor tendon involvement in the wrist joint of patients RA and analyze their relatioship with synovitis of radiocarpal (RC) and intercarpal (IC) joints
Methods Fifty consecutive RA patients (36 female, mean age 48) with bilateral wrist pain were included in the study. The extensor tendons (ET) were scanned bilaterally of the all 6 compartments on the dorsal aspect of the wrist. The presence of US findings indicative of synovitis of RC and IC joints and also ET tenosynovitis was investigated using grey-scale (GS) and power Doppler (PD) US scoring (semi-quantitative range 0-2 for both).
Results Synovitis of RC and IC joints was found in 29 (58%) and 27 (54%) respectively, of 50 RA patients. Analysing 100 wrists we found RC synovitis GS/PD in 58/49 (grade 1 49/45; grade 2 9/4) of patients respectively. We also found IC synovitis GS/PD in 51/48 (grade 1 47/44; grade 2 4/4) of patients respectively. Tenosynovitis of all six extensor compartements was found 9 (18%) of 50 patients.The most frequently involved were the extensor carpi ulnaris (ECU) and extensor digitorum communis tendons (EDC). Analysing all 100 wrists we found ECU tenosynovitis in 21/17 (grade 1 19/15; grade 2 2/2) of patients respectively. We also found EDC tenosynovitis in 12/12 (grade 1 10/12; grade 2 2/0) of patients respectively (Table 1). Presence of ECU and EDC tenosynovitis correlated with synovitis of both RC and IC joints: Among all 21 ECU, 18 (86%) were in wrists with RC synovitis and 16 (76%) in wrists with IC synovitis and among all 12 EDC, 10 (83%) were in wrists with RC synovitis and 9 (75%) in wrists with IC synovitis. However, 3 (14%) of ECU and 2 (17%) of EDC were found in wrists with no observations of RC or IC synovitis.
Conclusions The present study provides evidence of the ability of US to reveal a relatively high frequency of extensor tendon involvement at the wrist level in RA patients associated with involvement of the wrist joint. These data recommend US as a useful examination tool in daily clinical assessment of tendons and joints in RA.
Disclosure of Interest None declared
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