Appication Of Ultrasound In The Evaluation Of Finger, Toe And Wrist Joints Involvement In Patients With Rheumatoid Arthitis

Objective To investigate the application of ultrasound in the diagnosis of finger, toe and wrist joints involvement and to evaluate disease activity in patients with RA.Methods GSUS and PDUS were performed to assess Joint effusion/synovial proliferation, synovial vascularization and erosions on wrist, MCP, PIP and MTP of 56 patients with RA. Joint effusion/synovial proliferation, synovial vascularization and erosions were scored semiquantitatively(grade 0–3) at each joint. Global indices for joint effusion/synovial proliferation(GSUS score), synovial vascularization(PDUS score)and erosions were calculated for each patient. Tender joint count(TJC) and swollen joint count(SJC) on wrist, MCP, PIP and MTP were collected by a rheumatologist who was blindfolded to the US data. Disease Activity Score in 28 joints(DAS28),Erythrocyte sedimentation rate(ESR), hypersensitive C-reactive protein(hs-CRP)and rheumatoid factor(RF) were also collected for each patient.Results(1)In 56 RA patients, 45.5% of the joints had effusion/synovial proliferation, 14.0% of the joints had Synovial vascularization, 9.5% of the joints had erosions.(2)The GSUS score was significantly correlated with DAS28(P<0.001). The PDUS score was significantly correlated with DAS28, hs-CRP and ESR(P < 0.001). There was no significant correlation between erosions score and DAS28, hs-CRP and ESR(P>0.05).(3)Synovitis was detected by GSUS in 789 joints and by Clinical joint examination in 359 joints. More cases of synovitis were detected by GSUS than by Clinical joint examination, indicating a greater sensitivity of GSUS.(4)Concordance between clinical joint examination and GSUS was very low at the wrists(K=0.195) and MTP(K=0.112). At the MTP, concordance between clinical joint examination and PDUS was low(K=0.22) and at the wrists, there was clearly discordant between clinical joint examination and PDUS(P=-0.002). Concordance between clinical joint examination and US(both GSUS and PDUS) was moderate at MCP and PIP(0.4< K< 0.6).Conclusions(1)Ultrasound is a viable tool in the diagnosis and monitoring disease activity in patients with RA based on the fact that it could detect joint effusion/synovial proliferation, Synovial vascularization and erosions sensitively, and ultrasonographic indices has significant correlation with DAS28 and serological parameters.(2)GSUS is more sensitive than Clinical joint examination for detecting synovitis. US adds information to Clinical joint examination, most notably at the wrists and MTP.