Ultrasound detection of bone erosions in rheumatoid arthritis: a comparison to routine radiographs of the hands and feet.

Department of Radiology, The University of Alabama at Birmingham, 619 19th St. South, Birmingham, AL 35249-6830, USA.
Skeletal Radiology (Impact Factor: 1.74). 03/2004; 33(2):80-4. DOI: 10.1007/s00256-003-0693-2
Source: PubMed

ABSTRACT To determine if ultrasound (US) of selected joints in the hands and feet can detect more erosions than radiography and establish the presence of erosive disease in patients with rheumatoid arthritis (RA).
Eighty joints in ten patients with RA and 40 joints in five healthy control subjects, who were age, gender and ethnicity-matched to the patients with arthritis, were prospectively studied with radiographs and sonography. Conventional radiographs of the hands and feet were obtained. US examinations of the 2nd and 5th metacarpal-phalangeal (MCP) joints of the hands, and the 1st and 5th metatarsal-phalangeal (MTP) joints of the feet were performed. Radiographs and US exams were independently graded for the presence of erosions.
None of the control subjects had erosions. US detected erosions in 17/80, and radiographs detected erosions in 6/80 joints assessed with both modalities. US detected all erosions seen by radiographs in these selected joints. Erosive disease was present in the radiographs of seven of ten RA patients. US established erosive disease in eight of ten RA patients. US determined erosive disease in two of the three patients without radiographic erosions.
US of the MTP and MCP joints in RA can detect erosions not seen with radiography and may be complementary to radiography in establishing the presence of erosive disease in early RA.

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: This study aimed to assess the ability of ultrasonography (US) to predict radiographic damage in early arthritis. METHODS: ESPOIR is a multicentric cohort of early arthritis (i.e. ò 2 swollen joints between 6 weeks and 6 months). US synovitis in B mode and power Doppler (PD) and erosions were searched on MCP2 to 5 and MTP5 according to OMERACT definitions. Structural radiographic progression was assessed using the SHS erosion score at baseline, 1 and 2 years. Predictive factors of erosive arthritis at 2 years and rapid radiographic progression (RRP) at 1 year (defined by change of SHS erosion score ò 5) were searched. RESULTS: 127 patients were included: DAS28 5.1±1.3; 37.6% ACPA-positive; 27.6% with typical rheumatoid arthritis (RA) erosions on X-rays. At 2 years, 42 (39.2%) patients had typical RA erosions. US erosions predicted radiographic evidence of erosive arthritis (OR 1.44, 95% CI 1.04, 1.98). PD synovitis score was predictive of RRP at 1 year (OR 1.22, 95% CI 1.04, 1.42). US erosions and PD synovitis scores were associated with change of SHS erosion score on linear regression. On the 1184 analyzed joints, 105 (8.9%) had radiographic erosion at 1 year. At joint level, baseline US erosions were predictive of the presence of radiographic erosions at 1 year (p<0.001). The same trend was observed in the joints without radiographic erosions at baseline (p=0.052). CONCLUSION: US is useful to evaluate the potential severity of early arthritis: US erosions and PD positive synovitis have prognostic value to predict future radiographic damage. © 2012 by the American College of Rheumatology.
    Arthritis care & research. 12/2012;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Synovial disease is common in clinical practice and can have different causes. The development of high resolution ultrasonography (US) has led to greater use of US in the study of synovial disease. In this context, US is useful because (1) it can detect not only synovial disease, but also its consequences as tissue damage (erosions); (2) it can guide arthrocentesis when clinical attempts to obtain joint fluid have been unsuccessful, especially in joints that are difficult to access (hips), or sometimes when joint infections are clinically suspected; (3) it enables the efficacy of treatment for synovitis to be evaluated; and (4) it makes it possible to distinguish benign cystic lesions from other tumors. The overall evaluation of synovial disease is based on semiologic criteria that enables these alterations to be classified into four main groups: (a) joint effusion, (b) cystic synovial lesions, (c) intra-articular free bodies, and (d) synovial thickening.
    Radiología 04/2010; 52(4):301-10; quiz 377-8.
  • [Show abstract] [Hide abstract]
    ABSTRACT: With the establishment of the new American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for rheumatoid arthritis (RA) to diagnose patients earlier and with the introduction of early and aggressive treatment, the current aim is remission resulting in less functional disability, halting of radiographic damage, less pain, less fatigue and no loss of employment. These outcomes can be related to the World Health Organization International Classification of Functioning, Disability and Health (the WHO ICF framework). This framework includes the component body functions, body structures, activities and participation related to the disease. These components are related to each other in a bidirectional way and can be influenced by contextual factors including environmental and personal factors. This framework can be used to describe trends in RA outcomes and the impact of contextual factors on these outcomes. Despite aggressive treatment strategies, patients with RA still experience loss of function, pain and fatigue, and a relatively high proportion of patients have to take sick leave or become work disabled within the first few years of the disease. There is evidence that more stringent definitions of remission lead to greater improvement of outcomes and that the aim should be sustained remission and not just remission. There is, however, a need for a better understanding of the relation between contextual factors and activity and participation outcomes to better guide therapy decisions by rheumatologists and provide information to patients, families and policymakers about the impact of RA on their lives and to the society. The overall aim of this overview is to highlight the important contextual factors and consequences that relate to outcomes typically measured in RA studies and to demonstrate the additional benefits that can be achieved with remission and sustained remission.
    Best practice & research. Clinical rheumatology 08/2013; 27(4):555-70. · 2.90 Impact Factor