Finger Joints In Rheumatoid Arthritis Research Articles

Diagnostic value of high resolution B-mode and doppler sonography for imaging of hand and finger joints in RA

High-resolution sonography enables a detailed assessment of intra-articular and extra-articular soft tissue abnormalities of joints affected by rheumatoid arthritis (RA). B-mode sonography and power Doppler should be interpreted together with findings of clinical examinations and conventional radiography. In patients with RA, the wrists, the metacarpophalangeal joints, and the proximal interphalangeal joints can be involved and thus should be assessed with ultrasound in B-mode and power Doppler application, using a standardised technique. This examination can be time-consuming and for this reason multiple publications recommend to limit the examination to the most commonly involved joints such as the second and third MCP and PIP and the radiocarpal and radioulnar joints. The severity of acute synovitis correlates with the increased vascularity. With power/colour Doppler the inflammation is documented on a 3-point scale score which is suitable for follow-up examinations. Radiographs remain the baseline imaging modality for assessment of erosions but these are also easily detected by sonography. Sonography detects 20% more abnormalities than does radiography, and sonography has the potential to provide simple grading of disease activity. Thus, together with blood tests, sonography is excellent for monitoring the disease activity in RA and is considered as an extended diagnostic arm for clinical decisions. Learning objectives: 1. Understand the pathogenesis in RA that results in erosions and synovitis. 2. To be familiar with the sonographic findings and scoring systems. 3. Differentiation of osteoarthritis from RA.

Influence of plaque control on the relationship between rheumatoid arthritis and periodontal health status among Japanese rheumatoid arthritis patients.

Functional disability of the finger joints in rheumatoid arthritis (RA) patients could affect their oral hygiene and periodontal status because of poor plaque control. We examined the influence of plaque control on the relationship between the severity of RA and periodontal status in RA patients. This study recruited 89 Japanese RA patients who reported no difficulty in performing oral hygiene. We assessed RA severity using four indices: the Steinbrocker stage and class, the Health Assessment Questionnaire (HAQ) and the Disease Activity Score (DAS). Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were taken as parameters of periodontal status. Oral hygiene status was assessed using the plaque index (PlI). We examined the association between the severity of RA and periodontal parameters using multivariable linear regression analyses. In multivariable linear regression analyses not including PlI, Steinbrocker stage III-IV patients had significantly higher PlI scores and greater PD compared with those of stage I. The class III-IV patients had significantly higher PlI scores and greater PD. Patients with an HAQ score ≥0.5 had a significantly higher PlI score than those with an HAQ score of 0. However, when PlI was added to each multivariable model as an independent variable, no significant relationship between RA severity and periodontal status was observed. This study suggests that it is important to consider the influence of plaque control when assessing the relationship between RA severity and periodontal health status in RA patients.

Fluorescence optical imaging and 3T-MRI for detection of synovitis in patients with rheumatoid arthritis in comparison to a composite standard of reference

ObjectivesTo address whether Indocyanine Green (ICG) enhanced fluorescence optical imaging (FOI) is more sensitive than magnetic resonance imaging (MRI) in the detection of synovitis of the wrist and finger joints in rheumatoid arthritis and to analyze the performance of FOI depending on the grade of synovitis. MethodsTwenty patients with highly active rheumatoid arthritis (mean DAS28-ESR 5.25±1.0) and thirteen healthy volunteers underwent clinical examination, FOI and contrast-enhanced 3T-MRI. Joints were rated by three independent readers semiquantitatively (grade 0–3: no, low, moderate and high grade synovitis) and compared to a semiquantitative composite standard of reference (cSOR, grade 0–3) that incorporated clinical parameters, FOI and MRI results. Results2.868 evaluations in 956 joints were performed. FOI had an overall sensitivity of 57.3% and a specificity of 92.1%, whereas MRI had a sensitivity of 89.2% and a specificity of 92.6%. The sensitivity of FOI increased with the degree of synovitis to 65.0% for moderate and severe synovitis (specificity 88.1%) and 76,3% for severe synovitis (specificity 80.5%). The performance of FOI decreased with the degree of synovitis with false negative results predominantly for mild (156/343, 45.5%) and moderate (160/343, 46.6%) synovitis and false positive FOI evaluations predominantly based on weak (grade 1) signals (133/163, 81,6%). ConclusionFOI has a lower sensitivity than 3T-MRI in the detection of synovitis of the hand and finger joints. The diagnostic performance of FOI decreases with the degree of synovitis and with the strength of FOI signals.

Arthroscopy and arthroscopic synovectomy of finger joints in rheumatoid arthritis

Arthroscopy and arthroscopic synovectomy of finger joints in rheumatoid arthritis

Intra-individual assessment of inflammatory severity and cartilage composition of finger joints in rheumatoid arthritis.

To intra-individually assess the association of inflammation severity and cartilage composition measured by RAMRIS synovitis sub-score and delayed gadolinium-enhanced magnetic resonance imaging of the cartilage (dGEMRIC) of metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA). Forty-three patients with RA according to ACR/EULAR classification criteria (age 52.9 ± 14.5 years, range, 18-77 years) were included in this study. All study participants received 3-T MRI scans of the metacarpophalangeal joints of the second and third finger (MCP 2 and 3). The severity of synovitis was scored according to the RAMRIS synovitis sub-score by two readers in consensus. In the cases with identical synovitis sub-scores, two radiologists decided in consensus on the joint with more severe synovitis. Cartilage composition was assessed with dGEMRIC. To test the association of inflammation severity and cartilage damage and in order to eliminate inter-patient confounders, each patient's MCP 2 and 3 were dichotomized into the joint with more severe synovitis versus the joint with less severe synovitis for a paired Wilcoxon test of dGEMRIC value. There was a significant difference of dGEMRIC value (median of difference: 47.12, CI [16.6; 62.76]) between the dichotomized MCPs (p = 0.0001). There was a significant correlation between dGEMRIC value and RAMRIS synovitis grading of the joint with more severe synovitis (r = 0.5; p < 0.05) and the joint with less severe synovitis (r = 0.33; p < 0.05). Our data concur with the concept that synovitis severity is associated with cartilage damage. The local inflammatory status on a joint level correlated significantly with the extent of cartilage degradation in biochemical MRI.

Ultrasound of Synovitis in Rheumatoid Arthritis: Advantages of the Dorsal over the Palmar Approach to Finger Joints

To compare the dorsal and palmar ultrasound (US) examination of finger joints in early rheumatoid arthritis (RA) with regard to the concurrence of greyscale (GSUS) and power Doppler (PDUS) positivity, and to correlate both approaches with clinical variables. Patients with newly diagnosed RA were assessed by clinical examination and US. GSUS and PDUS of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were performed using the dorsal and palmar approach. Findings of synovitis in GSUS and PDUS were graded semiquantitatively from 0 to 3. Clinical and sonographic reevaluation was performed after 6 months. With 44.6% versus 32.2% positive findings, palmar GSUS identified significantly more joints with synovitis than did dorsal GSUS. With 22.1% versus 8.9%, PDUS abnormalities were detected significantly more often from the dorsal side. With 71.2% versus 21.8% for the MCP and 57.5% versus 17.4% for the PIP joints, significantly more GSUS and PDUS double-positive joints were found with the dorsal as opposed to the palmar approach. These differences remained significant at Month 6. Both palmar and dorsal GSUS and PDUS correlated with comparable strength with clinical variables such as the Disease Activity Score 28, Clinical Disease Activity Index, and Simple Disease Activity Index. Although the dorsal approach detected fewer GSUS findings than the palmar approach, PDUS signals were significantly more frequently detected by dorsal US. In addition, the prevalence of double-positive joints with concurrent GSUS and PDUS findings was significantly higher with the dorsal approach. These data argue in favor of the dorsal US approach to finger joints in RA.

AB1278 Palmar and dorsal ultrasound – differences in the detection of synovitis in RA patients

ObjectivesTo identify differences in the prevalence of synovitis between palmar and dorsal ultrasound (US) in patients with rheumatoid arthritis (RA). Further to compare US findings with clinical and laboratory parameters.MethodsUltrasound...

Effect of intra-articular corticosteroid injections and inflammation on periarticular and generalised bone loss in early rheumatoid arthritis

ObjectivesTo explore the effect of intra-articular corticosteroid (IAST) injections on bone mineral density (BMD) in the hand and at the metacarpophalangeal (MCP) joints in early rheumatoid arthritis (RA).MethodsIn the first...

Power Doppler Sonography and Pulse-Inversion Harmonic Imaging in Evaluation of Rheumatoid Arthritis Synovitis

This study evaluates the value of contrast-enhanced pulse-inversion harmonic imaging (PIHI) to detect synovial vascularization and thus the therapeutic effects of prednisolone treatment on the inflammation in finger joints in rheumatoid arthritis (RA). Before and after 7 days of mid- to high-dose steroid therapy, blood tests and clinical and sonographic examinations were assessed in 14 patients. Two hundred eighty finger joints (metacarpophalangeal [MCP] I-V, interphalangeal [IP], and proximal interphalangeal [PIP] II-V) were investigated on power Doppler sonography to determine, in each patient, the finger joint with the strongest hypervascularization and to score the synovial vascularization. Further dynamic examination of the selected joint was performed on PIHI after i.v. administration of a second-generation sonographic contrast medium. Vascularization was quantified by calculating the area under the time-intensity curves. The changes in signal intensities before and after therapy were correlated with clinical examinations (disease activity score [DAS]). The score of the joint with the strongest hypervascularization assessed by power Doppler sonography decreased significantly from 1.7 to 1.3 (p < 0.01); however, in six patients, no change was assessed after steroid therapy. In all patients, a significant reduction in PIHI signals was observed after therapy (p < 0.05). The baseline and follow-up median values of the area under the time-intensity curves were 8.56 +/- 1.28 and 7.65 +/- 0.66, respectively. The median values of the DAS decreased significantly from 4.90 +/- 0.86 to 3.6 +/- 1.0 (p < 0.01) 7 days after the steroid therapy. PIHI and power Doppler sonography enable the detection of synovial perfusion alterations after steroid therapy and, therefore, may be useful tools for the evaluation of active inflammation in RA and for the assessment of therapeutic response. However, minor changes of synovial vascularization can be better detected on PIHI than on power Doppler sonography.

Long-term follow-up imaging study comparing clinical examination, ultrasound and radiography in rheumatoid arthritis finger joints

Problemstellung: To compare clinical examination (CE), conventional radiography (CR) and ultrasound (US) in the detection of bone erosions and synovitis in rheumatoid arthritis (RA) finger joints in a long-term follow up study. In addition, to determine whether radiographically occult finger joint erosions – previously detected by US – would present on conventional radiographs seven years later.

Diagnostic Value of High-Resolution B-Mode and Doppler Sonography for Imaging of Hand and Finger Joints in Rheumatoid Arthritis

Diagnostic Value of High-Resolution B-Mode and Doppler Sonography for Imaging of Hand and Finger Joints in Rheumatoid Arthritis

Long-term results of synovectomy of the finger joints in rheumatoid arthritis

The effectiveness of surgical synovectomy of finger joints were clinically and radiologically evaluated. One hundred and sixty-one finger joints (MP 72, PIP 70, DIP 10 and IP 9) of 64 hands of 52 patients with rheumatoid arthritis who had a surgical synovectomy were examined at an average of 6.7 years follow-up (range 5.2–17 years). The results of synovectomy in these patients were evaluated according to five factors: recurrence of synovial swelling, relief of pain progression of deformity, progression of radiological change, and changes in range of motion after surgery. Un-operated fingers which were not swollen at the time of surgery were used as the controls. Recurrence of synovial swelling was seen in 12% of the patients at the follow-up examination and pain in the finger joints had developed in 6%. In almost all patients, the anti-inflammatory effects of surgery persisted for more than 5 years. Twenty-two (14%) PIP and MP joints showed postoperative progression of clinical deformity. Fifty-seven joints (35%) showed progression of bone change or articular rheumatoid lesion upon radiological examination. Each of the four clinical factors (pain, swelling, deformity and motion) improved more in the treated fingers than the un-operated control fingers. Although only 33% of the MP and PIP joints experienced no loss of motion in the operated joints after surgery, loss of motion occurred to only a small extent (10–15°) and few patients experienced difficulties with daily activities. The results of this clinical study suggest that surgical synovectomy for rheumatoid finger joints has anti-inflammatory effects as well as a prophylactic effect on the development of deformity and the progression of bony change after surgery.

Long-term results of synovectomy of the finger joints in rheumatoid arthritis

The effectiveness of surgical synovectomy of finger joints were clinically and radiologically evaluated. One hundred and sixty-one finger joints (MP 72, PIP 70, DIP 10 and IP 9) of 64 hands of 52 patients with rheumatoid arthritis who had a surgical synovectomy were examined at an average of 6.7 years follow-up (range 5.2–17 years). The results of synovectomy in these patients were evaluated according to five factors: recurrence of synovial swelling, relief of pain progression of deformity, progression of radiological change, and changes in range of motion after surgery. Un-operated fingers which were not swollen at the time of surgery were used as the controls. Recurrence of synovial swelling was seen in 12% of the patients at the follow-up examination and pain in the finger joints had developed in 6%. In almost all patients, the anti-inflammatory effects of surgery persisted for more than 5 years. Twenty-two (14%) PIP and MP joints showed postoperative progression of clinical deformity. Fifty-seven joints (35%) showed progression of bone change or articular rheumatoid lesion upon radiological examination. Each of the four clinical factors (pain, swelling, deformity and motion) improved more in the treated fingers than the un-operated control fingers. Although only 33% of the MP and PIP joints experienced no loss of motion in the operated joints after surgery, loss of motion occurred to only a small extent (10–15°) and few patients experienced difficulties with daily activities. The results of this clinical study suggest that surgical synovectomy for rheumatoid finger joints has anti-inflammatory effects as well as a prophylactic effect on the development of deformity and the progression of bony change after surgery.

Analgesic Effect of Low Energy Laser to Finger Joints in Rheumatoid Arthritis

Analgesic Effect of Low Energy Laser to Finger Joints in Rheumatoid Arthritis

Arthroplasty of finger joints in rheumatoid arthritis with use of silicone rubber prostheses

Arthroplasty of finger joints in rheumatoid arthritis with use of silicone rubber prostheses

RHEUMATOID HAND DEFORMITIES CONSIDERED IN THE LIGHT OF TENDON IMBALANCE. I

1. The posture of deformed finger joints in rheumatoid arthritis needs close analysis in terms of disturbed muscle balance. Although disorganisation of the joint itself may be the primary factor in the development of deformity, the deformity is often secondary to an extrinsic disturbance of muscle balance. 2. The part played by tendon ruptures in producing such imbalance is discussed.

Ankylosis of the Finger Joints in Rheumatoid Arthritis

Ankylosis of the Finger Joints in Rheumatoid Arthritis