Objectives Ultrasonography (US) is a useful method for assessing synovial vascularization and proliferation in rheumatoid arthritis (RA). The aim of the study is to compare the tender joint and swollen joint in patients with rheumatoid arthritis (RA) with gray scale (GS) and power doppler (PD) ultrasonography (US).
Methods Thirty RA patients were included. Median disease duration was 53.7 months. Demographic and clinical data, C reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were recorded for each patient. Disease activity was evaluated using the Disease Activity Score in 28-joints (DAS28) with a median score 3.8.The joint tenderness and swelling were assessed for 10 joints (wrists, second and third proximal interphalangeal and metacarpophalangeal) in each patient.These joints were evaluated by GS and PD by ultrasonography. US joint effusion, synovitis and PD signals were graded from 1 to 3 for each joints. The 10-joint GS and 10-joint PD scores were then calculated. Correlations were tested using the Spearman coefficient.
Results GS effusion, synovitis scores (r =0.565, p<0.001) and PD signals (r =0.883, p<0.001) correlated highly with the corresponding swollen joints. There was a significant correlation between DAS28 and number of tender joints (r=0.745, p<0.001) but no correlation was found between the tender joints and ultrasonographycal effusion, synovitis grade (r=0.073, p>0.001) and the PD signal (r=0.069, p>0.001). There was moderate correlation between 10 joints GS, 10 joints PD and DAS28, but it was not statistically significant.
Conclusions Evaluating the swollen joints with clinical examination and combining it with US is a sensitive method. As joint tenderness is a more subjective finding than the joint swelling, this may explain the lack of correlation between tender joints and ultrasonography findings. We suggest to use Gray scale US and PD as a complementary method in addition to clinical assessment of joint tenderness in patients with RA.
Disclosure of Interest None declared