Background Differential diagnosis of rheumatoid arthritis today is challenging in cases of atypical clinical and laboratory picture arthritis . Often the use of standard x-ray is not informative for the first two years of the disease. Erosive joint damage detected by the standard X-ray only after 2 years from the onset of the disease and only 36% of cases (M. Bukhari [et al., 2001), while the degree of articular destruction progresses with time and is correlated with a decrease in joint function.
Objectives Development ultrasound semiotics for the diagnosis of rheumatoid arthritis using ultrasonic method of investigation of the joints.
Methods We studied 113 patients with RA and 30 with no articular pathology – a control group (CG).
In the group of patients with RA - 88 people were women (79,7%), 35 people (20,3%) were men; the median age was 40.3 years (33–46), and the median duration of current RA – 4 years (1,75–10).
The diagnosis of RA was established according to modified ACR criteria of 1987. The activity of the inflammatory process of the I degree was 19 (27,5%) patients, II – 36 (52,2%), III in 14 (20.3%).
The control group was the patients medical history and clinically at the time of inspection there was no symptoms of the joints. Among them 15 men (50%) and 15 women (50%). The median age in the CG was 38.5 years (33–48).
All patients were multiplescale dynamic study II, V metacarpophalangeal and wrist joints by the ultrasonic device expert class using a sensor with a frequency of 12 MHz.
Results Patients from the control group by ultrasound examination of the joints, we visualized the articular surfaces of the bones in the form of hyperechoic structures with clear smooth contours, homogeneous echostructure; the synovium is not visualised or she had homogeneous echostructure and a thickness of not more than 2.9 mm; the tendon was determined in the form of a hyperechogenic bundle, of a thickness not exceeding 1.5 mm.
Patients with RA identified the following ultrasound signs of lesions of the joints: focal pannus (96,6%) - area of pathologically altered synovial membrane thickness of more than 3 mm with a “tumor-like” invasive growth and the presence of pathological vascularization (indirect signs of neoangiogenesis) detected when using Doppler on the erosion pannus; thinning synovia outside erosion (99%); erosion, pannus (99%); combined erosion (96%); the erosion of inflammation: acute (45.6%) and chronic (89%); moderate synovitis (89,4%); swelling of periarticular soft tissues (88,4%); tenosynovitis (67,6%); periarticular effusion (66,9%); positive “pain test” in 6% of cases under ultrasound control.
Conclusions Given the results obtained, we have developed ultrasonic diagnostic criteria of RA.
Diagnostic criteria for rheumatoid arthritis:
Pannus with pathological vascularization;
Thinning synovia outside of the pannus;
Erosion of the articular surface of the bone (pannus, associated erosion/erosion inflammation);
Raftery, G. Compresion of musculoskeletal ultrasound practices of a rheumatologist and a radiologist. G. Raftery, G. Hide, D. Kane. Rheumatology. 2007;232(3):519–522.
Disclosure of Interest None declared