A comparative study between ultrasonographic hand features in systemic sclerosis and rheumatoid arthritis patients: Relation to disease activity, clinical and radiological findings

Abstract

Aim of the workTo compare ultrasonographic (US) hand features in systemic sclerosis (SSc) and rheumatoid arthritis (RA) patients and to investigate their relationship with disease activity, clinical and radiographic data. Patients and methodsForty SSc and 30 RA patients were consecutively included. All patients underwent clinical examination, X-ray and US on the hand and wrist joints to detect synovitis, tenosynovitis, and calcinosis. Disease activity score-28 (DAS28) and European Scleroderma Activity index were used for RA and SSc patients respectively. Health Assessment Questionnaire-Disability Index (HAQ-DI) was used in all patients. ResultsThe frequency of synovitis and tenosynovitis detected by US was found to be higher than that found by clinical examination in both RA and SSc patients (p=0.01, p=0.02, respectively). US synovitis was detected in 10 SSc (25%) and in 17 RA patients (56%). US tenosynovitis was found in 18 SSc (45%) versus 11 RA patients (36.6%). US synovitis and tenosynovitis in RA patients showed a statistically significant correlation with the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, HAQ-DI and DAS28. Positive intrasynovial power Doppler signal was significantly frequent in RA than SSc patients (p<0.001). Sclerosing tenosynovitis appeared to be specific to SSc patients. Calcifications were observed in both SSc and RA patients, but with no statistically significant difference (p=0.69). ConclusionUS provided valuable disease activity information in both RA and SSc patients more than clinical examination. US articular involvement in SSc is less frequent compared to that in RA, with specific appearance of sclerosing tenosynovitis in SSc patients.