Newswise — WASHINGTON – Using sonograms, or ultrasound technology, to measure inflammation of the joint lining (synovitis) and detect joint damage may be a useful, less expensive tool in the examination of the effects of rheumatoid arthritis, according to new research findings presented this week at the American College of Rheumatology Annual Meeting in Washington, D.C.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, limitation of motion and loss of function of multiple joints. Though joints are the principal areas affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
Researchers based in São Paulo, Brazil, looked at how quantitative and semiquantitative ultrasound measurements might indicate RA in small, medium and large joints, helping physicians more accurately assess the impact of the disease.
“Recent studies already showed the importance of ultrasound in the assessment of subclinical arthritis, in attempting to diagnose and monitor RA patients,” says Flávia Machado, MD, lead researcher in the study from the Universidade Federal de São Paulo in Brazil. “We chose to study ultrasound measurement predictors of RA to help rheumatologists, who use ultrasound as an extension of the physical examination, and to help radiologists and sonographers when assessing a patient with synovitis who may have RA. However, ultrasound is not a diagnostic test for RA, since other diseases that also affect joints can present with similar sonographic measurements in some of the recesses.”
Dr. Machado and her colleagues studied 78 healthy volunteers and 60 patients with diagnosed RA according to ACR classification criteria. Quantitative measurements of synovial recesses and semiquantitative measurements of synovial hyperplasia, Power Doppler and bone erosions were conducted on an average of 6.348 joint recesses in the participants. Quantitative measures of RA related joint findings were detected fin almost all the joint recesses studied. Semiquantitative measurements showed that greater scores in the radiocarpal and ulnocarpal joints of the wrist, and the fifth MTP joint of the foot increased the likelihood of RA.
Analysis of the ultrasound scores showed no statistical differences between healthy and RA-affected joints in some cases. This may be due to the fact that RA affects each joint differently in individual patients, and also because some of the RA patients had few symptoms in some of the recesses studied, such as the hip and glenohumeral joints. “In general, ultrasound measurement of RA patients showed greater scores of synovial hypertrophy and power Doppler capitation,” says Dr. Machado. Visualization of bone erosion from ultrasound also greatly increases suspicion of RA.
Ultrasound has many advantages over other common imaging methods, including X-ray, in diagnosing joint disease, Dr. Machado says. “It is a real-time, dynamic, inexpensive and available bedside imaging tool. Many studies already proved ultrasound superior to physical examination in evaluation of subclinical synovitis or effusion. It is superior to X-ray in detection of bone erosion, and it may be used for monitoring RA patients in treatment with DMARDs or biologic agents.”
The American College of Rheumatology is an international professional medical society that represents more than 9,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.acrannualmeeting.org or join the conversation on Twitter by using the official hashtag: #ACR2012.
Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care. Also, discover the ACR’s Simple Tasks campaign, which highlights the severity of rheumatic diseases and the importance of early and appropriate referral to a rheumatologist.
Editor’s Notes: Flávia Machado, MD will present this research during the ACR Annual Meeting at the Walter E. Washington Convention Center at 9:00-11:00 AM in Poster Hall (Hall B) on Sunday, November 11. Dr. Machado will be available for media questions and briefing at 1:30 PM on Tuesday, November 13 in the on-site press conference room, Room 203 A-B
Presentation Number: 807
Predictors of Rheumatoid Arthritis: Quantitative and Semiquantitative Sonographic Measurements of Peripheral Joints
Flavia S. Machado (Universidade Federal de São Paulo, São Paulo, Brazil)Rita N.V. Furtado (Universidade Federal de São Paulo, São Paulo, Brazil)Rogerio D. Takahashi (Universidade Federal de São Paulo, São Paulo, Brazil)Ana Leticia P. de Buosi (Universidade Federal de São Paulo, São Paulo, Brazil)Jamil Natour (Universidade Federal de São Paulo, São Paulo, Brazil)
Background/Purpose: Sonographic quantitative and semiquantitative measurements in peripheral joints of normal subjects are yet to be defined, as are sonographic predictors of rheumatoid arthritis (RA). Our objetive was to estimate quantitative and semiquantitative ultrasound measurements predictors of RA in small, medium and large joints.
Methods: A cross-sectional study was carried out involving 78 healthy volunteers (HV) and 60 patients with RA (ACR), matched for age group and gender. A "blind" radiologist used a My Lab 60 XVision machine (Esaote, Biomedica - Genova, Italy) with a linear array (6-18MHz) to evaluate 6.348 joint recesses. Quantitative measurements of synovial recess (QSR) (mm) and semiquantitative measurements of synovial hyperplasia (SSH), Power Doppler (SPD) and bone erosion (SBE) (scores 0-3) were performed. To determine the chance to detect RA, ROC curve analysis for QSR measurements were performed (specificity 98.7%) and, for the semiquantitative measures, an univariate logistic regression (expressed in odds ratio - OR) was carried out. P value <0.05 was set as significant.
Results: The mean age (± SD) was 46.48 (9.14) and 43.89 (9.09), respectively for the HV and RA groups. The sample was homogeneous for gender, age group and skin color. RA group: mean disease duration was 7.89 years (± 6.76) and DAS-28 4.20 (± 1.71). Statistical difference was observed between groups for QSR (p<0.013) for most of the recesses. Mean (±SD) (mm) of QSR, respectively for HV and RA groups (HV/RA), were: radiocarpal: 2.07 (0.56)/3.24 (1.24); distal radioulnar: 1.45 (0.37)/2.28 (1.11); ulnocarpal: 1.37 (0.59)/2.74 (1.76); dorsal 2ndMCP: 1.06 (0.53)/1.51 (0.96); palmar 2ndMCP: 0.88 (0.60)/1.40 (1.01); dorsal 3rdMCP: 0.81 (0.62)/1.24 (0.99); dorsal 2ndPIP: 0.46 (0.25)/0.76 (0.64); dorsal 3rdPIP: 0.44 (0.32)/0.83 (0.56); palmar 3rdPIP: 0.83 (0.27)/1.11 (0.55); coronoid fossa: 0.97 (1.06)/2.18 (2.27); olecranean fossa: 1.51 (1.17)/2.79 (2.65); posterior GH recess: 2.43 (0.45)/3.03 (1.29); knee: 2.21 (1.65)/3.95 (2.96); talocrural: 2.38 (1.13)/3.34 (1.99); talonavicular: 2.67 (1.10)/3.56 (1.50); subtalar: 2.15 (1.13)/3.07 (1.71); dorsal 5thMTP: 0.72 (0.70)/1.47 (1.11). Cutoff values of QSR specific of RA (AUC>0,700) were: radiocarpal 3.78mm; ulnocarpal 3.07mm; distal radioulnar 2.21mm; dorsal 3rd PIP 1.19mm; knee 6.7mm and dorsal 5th MTP 2.33mm. For semiquantitative measurements, progression from score 0 to 3, at the recesses with greater chance to detect RA were: SSH: ulnocarpal (OR=100, p<0.001); radiocarpal (OR=70, p<0.001); distal radioulnar (OR=43, p<0.001) and knee (OR=28, p<0.001); SPD: radiocarpal (OR=66, p<0.001); SBE: radiocarpal (OR=324, p=p<0.001); lateral 5thMTP (OR=100, p=p<0.001); 2nd MCP (dorsal and radial)(OR= 92, p<0.001) and ulnocarpal (OR=48, p<0.001). Inter-observer reliability for quantitative and semi-quantitative measures ranged from 0.563 to 0.872 and 0.341 to 0.823, respectively.
Conclusion: Quantitative measures specific of RA were found in almost all recesses. Semiquantitative measurements analysis showed that the worst scores found at radiocarpal, ulnocarpal and lateral 5thMTP recesses increases the chance to detect RA. Disclosure: F. S. Machado, None; R. N. V. Furtado, None; R. D. Takahashi, None; A. L. P. de Buosi, None; J. Natour, None.
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