Ultrasound Assessment of Synovial Thickness of Some of the Metacarpophalangeal Joints of Hand in Rheumatoid Arthritis Patients and the Normal Population.

Zuhudha Hussain Manik,John George,Sargunan Sockalingam

doi:10.1155/2016/5609132

Zuhudha Hussain Manik, John George + Show 1 more

Open Access

https://doi.org/10.1155/2016/5609132

Copy DOI

Journal: Scientifica	Publication Date: Jan 1, 2016
Citations: 20	License type: CC BY 4.0

Affiliation: University of Malaya

Abstract

Objective. To compare ultrasound synovial thickness of the 2nd, 3rd and 4th metacarpophalangeal joints (MCPJ) in a group of patients with proven rheumatoid arthritis (RA) and a control group of normal individuals. Materials and Methods. This is a cross-sectional study comprising 30 rheumatoid arthritis patients and 30 healthy individuals. Ultrasound scans were performed at the dorsal side of 2nd, 3rd, and 4th MCPJ of both hands in RA patients and the healthy individuals. Synovial thickness was measured according to quantitative method. The synovial thickness of RA patients and healthy individuals was compared and statistical cut-off was identified. Results. Maximum synovial thickness was most often detected at the radial side of the 2nd MCPJ and 3rd MCPJ and ulnar side of the 4th MCPJ of both hands which is significantly higher (p < 0.05) in RA patients compared to healthy individuals. With high specificity (96%) and sensitivity (90%) the optimum cut-off value to distinguish RA patients and healthy individuals' synovial thickness differs for the radial side of the 2nd and 3rd MCPJ and ulnar side of the 4th MCPJ. Conclusion. Patients with early RA appear to exhibit a characteristic pattern of synovitis which shows radial side predominance in the 2nd and 3rd MCPJ and ulnar side in the 4th MCPJ.

Highlights

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that, if left untreated, will eventually cause progressive joint destruction and deformity resulting in irreversible long term disability [1].RA has a favourable outcome if diagnosed early and treated aggressively if needed with disease-modifying antirheumatic drugs [2,3,4]
We found most of the synovitis at the radial side of the 2nd and 3rd metacarpophalangeal joints (MCPJ) and the ulnar side of the 4th MCPJ
In this study we found a characteristic pattern of maximum synovitis, involving the radial side of 2nd and 3rd MCPJ and the ulnar side of the 4th MCPJ

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that, if left untreated, will eventually cause progressive joint destruction and deformity resulting in irreversible long term disability [1].RA has a favourable outcome if diagnosed early and treated aggressively if needed with disease-modifying antirheumatic drugs [2,3,4]. The early recognition of reversible synovitis in RA and close monitoring of disease activity are of great importance to avoid the likelihood of persistent disease and irreversible joint damage. Some studies showed that when scoring the synovial lining in normal subjects using grey-scale ultrasound (US) scoring systems for synovial hypertrophy, high number of joints was scored as pathological. It showed that grade 1 of semiquantitative scoring was not specific for RA patients but was detected in the joints of healthy individuals [9,10,11]. This indicates that grey-scale ultrasound scores interpreted as pathological in patients with RA may sometimes be normal findings. It is important to define standard reference values for normal synovial thickening in healthy individuals to prevent misinterpretation of synovial thickening as pathological

Methods

Discussion

Conclusion