Background Musculoskeletal Ultrasound Assessment (US) is increasingly used as a valid and reliable tool for guiding the management of inflammatory arthritides. However its use in Systemic Lupus Erythematosous (SLE) and Sjogren's Syndrome (SS) in clinical practice remains limited1, thus potentially missing an opportunity to appreciate severity of joint involvement and optimise management2.
Objectives To analyse a real life cohort of SLE and SS patients referred for US assessment on clinical grounds, to review their characteristics and whether US assessment led to a change in treatment.
Methods Retrospective analysis of real life data from a dedicated rheumatology US clinic at a tertiary referral hospital. The OMERACT scoring system was used for the US examination of 22 hand joints in every patient (wrists, metacarpo-phalangeal and proximal interphalangeal (PIP) joints bilaterally).
Results Over a 2 year period (01/2014–12/2015) a total of 604 patients were scanned including 19 with SLE and 17 with SS. Patient characteristics and differences between their US outcomes are shown in table 1. US assessment prompted treatment change in 84% of SLE patients and 82% of SS cohort. ESR showed a better association with swollen joint count in SS (r=0.29) than SLE (r=0.17), however this did not reach statistical significance. A subanalysis of the SLE cohort showed poor correlation of the MSK BILAG items scores with active joint disease defined as PD presence on US (r=0.189, p=0.5).
Conclusions US assessment led to significant change in management for both cohorts. The SLE group had more active disease on US than SS, despite similar swollen joint count and increased prednisolone. There was poor correlation of US disease activity and MSK BILAG in SLE patients, suggesting that US can provide additional information in identifying active joint disease. US proves a useful and reliable tool to monitor musculoskeletal features and therapeutic outcomes in both SLE and SS patients that can be used routinely in real life clinical practice.
Zayat AS et al. The role of ultrasound in assessing musculoskeletal symptoms of systemic lupus erythematosus: a systematic literature review. Rheumatology (Oxford). 2015 Oct 7
Mosca, M et al. The role of imaging in the evaluation of joint involvement in 102 consecutive patients with systemic lupus erythematosus. Autoimmun Rev. 2015 Jan;14(1):10–5
Disclosure of Interest None declared