Rheumatology Advance Access originally published online on August 9, 2006
Rheumatology 2007 46(3):454-459; doi:10.1093/rheumatology/kel256
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
A comparison of clinical vs ultrasound determined synovitis in rheumatoid arthritis utilizing gray-scale, power Doppler and the intravenous microbubble contrast agent ‘Sono-Vue’®
Department of Rheumatology and 1Department of Radiology, St George's Healthcare NHS Trust, London, UK.
Correspondence to: Dr P. D. W. Kiely, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK. E-mail: patrick.kiely{at}stgeorges.nhs.uk
 |
Abstract |
|---|
Objectives. Synovitis in rheumatoid arthritis (RA) is assessed clinically by the presence of joint tenderness and swelling. Synovial thickening and increased vascularity may also be detected by high-resolution ultrasonography (US) and power Doppler (PD). This study investigated the relationship between clinical and sonographic features of synovial disease utilizing US, PD and the contrast agent Sono-Vue®.
Methods. Forty RA patients were recruited. One proximal inter-phalangeal or metacarpophalangeal joint was selected per patient, as being unambiguously either: swollen and tender, just swollen, just tender or neither swollen nor tender (Nil). Ten joints were selected per clinical group. On US, the mean synovial thickness was measured and synovial hypertrophy and erosions were graded subjectively. Synovial vascularity demonstrated by PD was scored subjectively pre- and post-contrast.
Results. All grades of synovial vascularity were found in each clinical group including the Nil group. There were significant differences between the four clinical groups for both synovial hypertrophy (P = 0.024) and PD scores pre- (P = 0.022) and post- (P = 0.039) contrast. Tender-only joints showed significantly less vascularity than other groups. Post-contrast, the median PD scores increased in all but the Nil group, in some cases from the normal to abnormal range.
Conclusion. Synovitis demonstrated by US and PD is not predicted by patterns of disease as described by joint swelling and tenderness despite unambiguous selection of joints. Synovial vascularity was the least in tender-only joints and was heterogeneous in all other groups, including Nil joints. These findings question the reliability of traditional clinical signs in RA synovitis assessment.
KEY WORDS: Rheumatoid arthritis, Synovitis, Ultrasound, Power Doppler, Sono-Vue, Joint tenderness, Joint swelling
Submitted 25 January 2006;
revised version accepted 21 June 2006.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. Hameed, J. Pilcher, C. Heron, and P. D. W. Kiely The relation between composite ultrasound measures and the DAS28 score, its components and acute phase markers in adult RA Rheumatology, April 1, 2008; 47(4): 476 - 480. [Abstract] [Full Text] [PDF]
|
|