Abstract
Background The use of musculoskeletal ultrasound in rheumatoid arthritis (RA) has been growing over the last decades mainly to monitor response to treatment and for early detection of erosions. Suggestions to include this technique in the diagnosis of RA have been made, but not yet been implemented (because of the lack of specific sonographic criteria for RA). Objectives To verify the performance of a proposed combined structural and synovial scoring system in differentiating RA from osteoarthritis (OA) and healthy sonographic findings in the small joints of the hand. Patients and methods Twenty RA patients, 20 patients with hand OA, and 10 healthy controls were subjected to musculoskeletal ultrasound of the metacarpophalyngeal and proximal interphalyngeal joints. The novel proposed scoring system was applied characterizing each joint as either RA supported or RA unsupported. Grading of synovitis as mild, moderate, or severe was also performed. In the RA group, disease activity was assessed by Disease Activity Score 28 (DAS28) and anticyclic citrullinated peptide serum levels were measured. Results When one or more RA-supported joints were detected using this scoring system, it had a sensitivity of 100.0% and a specificity of 83.0%, with a diagnostic accuracy of 90.0%, for the diagnosis of RA. If two or more joints were detected, it had a sensitivity of 95.0% and a specificity of 96.7%, with a diagnostic accuracy of 96.0% for the diagnosis of RA. Conclusion The novel suggested combined structural and synovial scoring system showed high performance in differentiating RA from OA and controls.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory disorder in which the immune system targets synovial joints and causes mild to severe joint destruction with extra-articular manifestations
When one or more RA-supported joints were detected using this scoring system, it had a sensitivity of 100.0% and a specificity of 83.0%, with a diagnostic accuracy of 90.0%, for the diagnosis of RA
This study was cross-sectional and was carried out on 20 RA patients diagnosed according to the American College of Rheumatology (ACR) 1987 criteria [19], 20 patients with hand OA diagnosed according to the ACR 1990 criteria [20], and 10 healthy volunteers with no hand complaints or systemic arthritis
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory disorder in which the immune system targets synovial joints and causes mild to severe joint destruction with extra-articular manifestations. Conventional radiography has long been the standard method of identifying progressive joint damage in arthritis This method is, not sensitive for the detection of soft tissue changes, for example, synovitis, and usually does not reveal early erosive lesions [4,5]. The use of musculoskeletal ultrasound in rheumatoid arthritis (RA) has been growing over the last decades mainly to monitor response to treatment and for early detection of erosions. Suggestions to include this technique in the diagnosis of RA have been made, but not yet been implemented (because of the lack of specific sonographic criteria for RA). In the RA group, disease activity was assessed by Disease Activity Score 28 (DAS28) and anticyclic citrullinated peptide serum levels were measured
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