Background Muskuloskeletal ultrasound (US) is used for the detection of inflamed soft tissue and erosive changes in patients with inflammatory joint diseases.

Objectives To evaluate patient-related correlates to persistent power Doppler ultrasound (PDUS) signals and to the development of new erosions at 12 months.

Methods A total of 160 patients with early inflammatory arthritis (symptoms <6 months) were followed-up by musculoskeletal ultrasound (US) at 0 and 12 months. A structured protocol of validated US items was used on the basis of the US7 score [1], including the B-mode and PDUS examination of the clinically most affected hand and foot (wrist, ECU, MCP2,3 and MTP2,5). The results were graded semiquantitatively (0-3). A sumscore was obtained from all synovitis gradings in B-Mode (0-21) and PDUS (0-21). Erosions were reported as present/absent in wrist and MCP2,3 (0-3). Correlates of a PDUS score ≥1 and novel erosions at 12 months were determined using logistic regression analyses.

Results At baseline, 126 patients (79%) presented with a B-mode sumscore ≥2 and 108 patients (68%) had a PDUS sumscore ≥1. The mean clinical values at baseline were: age: 56 years, symptom duration: 13 weeks, DAS28: 5.1, ESR: 31mm/h, SJC: 7, TJC: 11. At 12 months, a total of 33 patients (21%) had an ongoing PDUS score >1 that correlated with ongoing clinical activity (mean ESR 27mm/h, SJC 4). In the multivariate logistic regression analysis, current smoking (OR 3.1), hypertension (OR 2.9) and the TJC (OR 1.1) were significantly associated with a PDUS score >1 at 12 months. The development of new erosions (in 12 (5%) of the patients) at 12 months was associated with a high B-mode synovitis score >6 (OR 12.1, p<0.01).

Conclusions Current smoking and hypertension increase the probability to have persistent PDUS activity in inflammatory arthritis. As both can cause endothelial damage, an increasing vulnerability of the synovial tissue can be expected.

References

1. Backhaus M, Ohrndorf S, Kellner H, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009 Sep 15;61(9):1194-201.

Acknowledgements The observational cohort was funded by an unconditional grant from Pfizer.

Disclosure of Interest None declared