Ultrasonography Supplements Clinical Exam to Improve Early Rheumatoid Arthritis Disease Activity Monitoring in Metatarsophalangeal Joints

Overview

Journal Clin Rheumatol

Publisher Springer

Specialty Rheumatology

Date 2020 Jan 8

PMID 31907694

Citations 3

Authors

Hanyan Zou

Karen A Beattie

Myriam Allen

George Ioannidis

Maggie J Larche

Affiliations

Soon will be listed here.

Abstract

Introduction: Compared with clinical examination (CE), ultrasonography (US) provides additional and more accurate assessment of inflammation and visualization of structural damage. To better understand the effectiveness of US in metatarsophalangeal joints (MTPJs), we compared disease activity in MTPJs 2-5 assessed by CE and US, with magnetic resonance imaging (MRI) as reference standard.

Method: Treatment-naïve adult patients with early RA (ACR criteria, disease duration < 2 years) were consecutively recruited. MTPJs 2-5 were assessed for swelling and tenderness, and imaged by US (Esaote MyLab70). The most symptomatic foot was imaged by peripheral MRI (1.0 Tesla). US was semiquantitatively graded for synovial thickening (ST) and power Doppler (PD) (0-3), and erosions (yes/no). MRI was semiquantitatively graded for bone marrow edema (BME), synovitis, and erosions (OMERACT). Kappa agreement, sensitivity, specificity, and predictive values were analyzed using cut-offs at ST ≥ 2, PD ≥ 1, and MRI synovitis and BME at both ≥ 1 and ≥ 2.

Results: This study included 39 patients (85% female, mean (SD) age = 51.6 (10.3)). Using MRI synovitis and BME grade ≥ 2 as the reference, PD had superior sensitivity (82%) and kappa agreement (k = 0.43) than swollen joint count (55%, k = 0.20), but similar high specificity (88%, 83%). ST and PD were often observed in clinically asymptomatic MTPJs. US detected very few MRI erosions, but several observed erosions corresponded to grade ≥ 2 MRI erosions.

Conclusion: Clinical swelling and PD are highly specific for active inflammation in the MTPJs. US supplemented CE by allowing observation of subclinical inflammation and structural damage. Key Points • Ultrasonography detected many subclinical synovial inflammations in metatarsophalangeal joints (MTPJs), many confirmed by MRI • Ultrasonography may best be used clinically to supplement clinical examination by assessing non-swollen joints • Ultrasonography provided quick method of visualizing bone erosions that were grade ≥ 2 on MRI.

Citing Articles

Do Dynamic Plantar Pressures Differ Based on Sonographic Evidence of Metatarsophalangeal Joint Synovitis in People With Rheumatoid Arthritis?.

Anderson L, Ihaka B, Bowen C, Dando C, Stewart S ACR Open Rheumatol. 2023; 6(3):113-122.

PMID: 38117793 PMC: 10933642. DOI: 10.1002/acr2.11635.

High-Resolution Ultrasound of the Forefoot and Common Pathologies.

Chen X, Zhou G, Xue H, Wang R, Bird S, Sun D Diagnostics (Basel). 2022; 12(7).

PMID: 35885448 PMC: 9322853. DOI: 10.3390/diagnostics12071541.

Musculoskeletal ultrasound for treating rheumatoid arthritis to target-a systematic literature review.

Silvagni E, Callegher S, Mauric E, Chiricolo S, Schreiber N, Tullio A Rheumatology (Oxford). 2022; 61(12):4590-4602.

PMID: 35512175 PMC: 9707059. DOI: 10.1093/rheumatology/keac261.

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