Abstract
BackgroundPersistent synovitis (PS) may lead to erosive joint damage and result in functional disability.ObjectivesThe aim of the study was to identify the risk factors for development of PS in early undifferentiated arthritis patients (EUA) attending Al Sharqia Governorate Hospitals, Egypt.Patients and methodsA total of 80 EUA patients comprised the patients group. Assessment was performed twice (baseline and after 1 year) using clinical, laboratory, functional, and radiological [high resolution ultrasonography (HRUS) and power Doppler (PD)] assessments.ResultsAmong 80 patients assessed, 20 (25%) showed evidence of self-limiting arthritis and 60 (75%) had PS (PS):16 (27%) developed rheumatoid arthritis, 14 (23%) progressed to spondyloarthropathy, and 30 (50%) remained undifferentiated (UA). Baseline tender and swollen Joint Counts (TJC and SJC) and anti-CCP2 titer were significantly evident in PS patients. Baseline HRUS total score of synovitis and PD total score were significantly higher in PS patients. Family history of any specific rheumatic disease, SJC, anti-CCP2 titer, HRUS total synovitis score, and PD total score were the significant risk factors of PS development. The most significant risk factor of PS (logistic regression analysis) was the baseline PD total score.ConclusionBaseline PD total score is the most significant risk factor for development of PS in EUA patients.RecommendationPD examination of all patients presenting with EUA should be performed.
Highlights
Patients with early arthritis are meant to be those with the potential for development of persistent synovitis (PS) but in whom a recognized clinical pattern does not exist [1]
Baseline data of the self-limiting arthritis (SLA) group and Persistent synovitis (PS) patients showed that family history of any specific rheumatic disease, TJC, SJC, and anti-CCP2 titer were significantly
This is in agreement with the finding of El Miedany et al [1], as they found that arthritis of the small joints of the hands and anti-CCP were significantly detected in persistent inflammatory arthritis patients
Summary
Patients with early arthritis are meant to be those with the potential for development of persistent synovitis (PS) but in whom a recognized clinical pattern does not exist [1]. Most patients with early arthritis cannot be diagnosed as a defined disease entity. Ultrasonography (US) is a relatively cheap and noninvasive imaging modality; multiple joints in a short period of time and bone structure as well as soft tissue can be examined. It has a better sensitivity than physical examination in the detection of synovitis in early arthritis [7]. Persistent synovitis (PS) may lead to erosive joint damage and result in functional disability
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