THU0160 Semi-quantitative and standardised sonographic investigations of the activity of inflamation in patients with rheumatoid arthritis

Abstract

Background With high-resolution sonography (US) of joints affected by rheumatoid arthritis (RA) a detailed delineation of intra- and extraarticular soft-tissue abnormalities is possible. Power-Doppler is useful for the analysis of the vascularisation of inflamed tissue. The aim of the study was to evaluate the diagnostic value of Power-Doppler and B-Mode US in context with clinical examinations and conventional radiography. Objectives Methods To date, in 22 patients (5 males, 17 females) with different grades of RA (17 RF+, 5RF-) the wrists and MCP I-V and PIP II-V were scored with sonography (ATL HDI 5000, 5‑12 MHz Transducer, synthetic plastic blocks) with B-Mode and Power-Doppler application in standardised technique. Extension and severity of the inflamed tissue as well as vascularisation were scored. The results were correlated with benchmarks of the clinical and radiologic investigations. Radiographs were assessed according to the Larsen Score. The amount of time of US investigation was measured. Results With sonography, both extension and severity of wrist lesions could be delineated to better advantage than with radiography and clinical examination. This was also true for the MCP joints with the exception of MCP II, where most of the lesions detected by radiography were found. From 484 joints, 29% were found to be abnormal by clinical investigations. Erosions were detected in 26% with radiography, in 37% with sonography. Hypervascularisation was found in 36%. No significant difference of US abnormalities between patient groups with positive and negative RF could be found. A modern state-of-the-art Power Doppler program release is a necessary tool for semi-quantification. A standardised investigation technique with a median amount of time of 18 min provides sufficient quality measures. Conclusion Sonography detects more bone erosions than radiography and clinical examination. It supports the diagnosis of RA manifestations of the hand. References Fitzgerald O, Bresnihan B. Synovial vascularity is increased in rheumatoid arthritis: comment on the article by Stevens, et al.[letter]. Arthritis Rheum. 1992;35:1540–41 Hau M, Schultz H, Tony HP, Keberle M, Jahns R, Haerten R, Jenett M. Evaluation of pannus and vascularization of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis by high-resolution ultrasound (multidimensional linear array). Arthritis Rheum. 1999;42(11):2303–8 Grassi W, Tittarelli E, Pirani O, Avaltroni D, Cervini C. Ultrasound examination of metacarpophalangeal joints in rheumatoid arthritis. Scand J Rheumatol. 1993;22:243–7