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Extended report
Ultrasound colour Doppler is associated with synovial pathology in biopsies from hand joints in rheumatoid arthritis patients: a cross-sectional study
  1. Martin Andersen1,2,
  2. Karen Ellegaard1,
  3. Josephine B Hebsgaard3,
  4. Robin Christensen1,
  5. Søren Torp-Pedersen1,
  6. Peter H Kvist3,
  7. Niels Søe4,
  8. John Rømer3,
  9. Nina Vendel5,
  10. Else Marie Bartels1,
  11. Bente Danneskiold-Samsøe1,
  12. Henning Bliddal1
  1. 1Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2Department of Translational Immunology, Biopharmaceutical Research Unit, Måløv, Novo Nordisk, Denmark
  3. 3Department of Histology, Biopharmaceutical Research Unit, Måløv, Novo Nordisk, Denmark
  4. 4Department of Orthopaedics, Section of Hand Surgery, Gentofte University Hospital, Gentofte, Denmark
  5. 5Department of Anaesthesiology, Intensive and day-care Surgery, Gentofte University Hospital, Gentofte, Denmark
  1. Correspondence to Professor Henning Bliddal, Department of Rheumatology, The Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, Frederiksberg, Copenhagen 2000, Denmark; hb{at}


Objectives Little is known regarding the association between ultrasound-determined pathological synovial blood flow and synovial pathology in rheumatoid arthritis (RA). We therefore examined the association between colour Doppler ultrasound imaging and synovitis assessed by histopathology and specific cell markers by immunohistochemistry in patients with RA.

Methods 81 synovial sites from wrist and finger joints from 29 RA patients were evaluated by ultrasound colour Doppler and subsequently biopsied by needle arthroscopy. The association between ultrasound colour fraction and an overall synovitis score and immunohistochemical staining for CD3, CD68, Ki67 and von Willebrand factor was investigated, including repeated samples from the same patients. The overall synovitis score (total 0–9) assessed synovial lining hyperplasia (0–3), stromal activation (0–3) and inflammatory infiltration (0–3). Data were clustered within patients, thus a linear mixed model was applied for the statistical tests. Parsimony in the statistical models was achieved omitting covariates from the model in the case of what was judged no statistical significance (p>0.1).

Results Doppler colour fraction showed an association with the overall synovitis score (approximated Spearman, approximately r=0.43, p=0.003). The density of all immunohistochemical stainings showed a significant association with Doppler colour fraction: von Willebrand factor (approximately r=0.44, p=0.01), CD68 (approximately r=0.53, p=0.02), Ki67 (approximately r=0.57, p=0.05) and CD3 (approximately r=0.57, p=0.0003).

Conclusions Colour Doppler activity is associated with the extent of inflammation present in the synovial biopsies from RA patients. However, synovial pathology was also seen in biopsies taken from Doppler negative sites.

  • Rheumatoid Arthritis
  • Ultrasonography
  • Synovitis

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