Is Active Synovitis of Metacarpophalangeal Joints a Neuropathic Condition in Rheumatoid Arthritis Patients? Results from an Ultrasound Study of Palmar Digital Nerves

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Mar 28

PMID 38541825

Authors

Marco Di Carlo

Jacopo Di Battista

Edoardo Cipolletta

Tadashi Okano

Riccardo Chiorrini

Gianluca Smerilli

Francesca Bandinelli

Emilio Filippucci

Fausto Salaffi

Affiliations

Soon will be listed here.

Abstract

(1) : Rheumatoid arthritis (RA) is a chronic inflammatory joint disease, primarily characterized by pain. A significant proportion of patients report symptoms suggestive of neuropathic pain. The objectives of this study were to investigate the presence of an increased cross-sectional area (CSA) of the palmar digital nerves by ultrasound in patients with active synovitis of the metacarpophalangeal joints and to identify potential predictors of such an increase. (2) : An ultrasound examination of the clinically most affected hand (from the second to the fifth metacarpophalangeal joint) was performed. The presence of synovitis was scored using a 0-3 semiquantitative method for each joint. The CSA of each pair of palmar digital nerves was measured. (3) : A significant correlation was found between the sum of the CSAs of the nerves and the Clinical Disease Activity Index (CDAI) (r = 0.387), as well as with the ultrasonographic grading of synovitis (r = 0.381) both at the patient and the joint level. These two variables, aimed at measuring disease activity, along with male gender, are the only predictors of the CSA of the palmar digital nerves. (4) : Synovial inflammation of the metacarpophalangeal joints is, therefore, a condition that can influence the CSA of the palmar digital nerves and may partially explain neuropathic pain in patients with RA.

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References

Chang K, Mezian K, Nanka O, Wu W, Lou Y, Wang J . Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications. J Clin Med. 2018; 7(11). PMC: 6262579. DOI: 10.3390/jcm7110457. View

Di Carlo M, Bianchi B, Cipolletta E, Farah S, Filippucci E, Salaffi F . Imaging of the peripheral nervous system in nociplastic pain: An ultrasound study in patients with fibromyalgia. J Neuroimaging. 2023; 33(4):558-565. DOI: 10.1111/jon.13104. View

Terslev L, Naredo E, Aegerter P, Wakefield R, Backhaus M, Balint P . Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. RMD Open. 2017; 3(1):e000427. PMC: 5597800. DOI: 10.1136/rmdopen-2016-000427. View

Bathala L, Kumar P, Kumar K, Visser L . Ultrasonographic cross-sectional area normal values of the ulnar nerve along its course in the arm with electrophysiological correlations in 100 Asian subjects. Muscle Nerve. 2013; 47(5):673-6. DOI: 10.1002/mus.23639. View

Carbone F, Bonaventura A, Liberale L, Paolino S, Torre F, Dallegri F . Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents. Clin Rev Allergy Immunol. 2018; 58(1):1-14. DOI: 10.1007/s12016-018-8714-z. View

Creange A, Barlovatz-Meimon G, Gherardi R . Cytokines and peripheral nerve disorders. Eur Cytokine Netw. 1997; 8(2):145-51. View

Hsieh P, Chang K, Wu Y, Ro L, Chu C, Lyu R . Cross-Sectional Area Reference Values for Sonography of Peripheral Nerves in Taiwanese Adults. Front Neurol. 2021; 12:722403. PMC: 8596614. DOI: 10.3389/fneur.2021.722403. View

Smerilli G, Di Matteo A, Cipolletta E, Carloni S, Incorvaia A, Di Carlo M . Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome. Clin Rheumatol. 2020; 40(3):1085-1092. PMC: 7895772. DOI: 10.1007/s10067-020-05293-z. View

McWilliams D, Walsh D . Pain mechanisms in rheumatoid arthritis. Clin Exp Rheumatol. 2017; 35 Suppl 107(5):94-101. View

10.

Zaottini F, Picasso R, Pistoia F, Sanguinetti S, Pansecchi M, Tovt L . High-resolution ultrasound of peripheral neuropathies in rheumatological patients: An overview of clinical applications and imaging findings. Front Med (Lausanne). 2022; 9:984379. PMC: 9661426. DOI: 10.3389/fmed.2022.984379. View

11.

Wu W, Chang K, Hsu Y, Tsai Y, Mezian K, Ricci V . Ultrasound Imaging and Guidance for Distal Peripheral Nerve Pathologies at the Wrist/Hand. Diagnostics (Basel). 2023; 13(11). PMC: 10253229. DOI: 10.3390/diagnostics13111928. View

12.

Filippucci E, Cipolletta E, Mirza R, Carotti M, Giovagnoni A, Salaffi F . Ultrasound imaging in rheumatoid arthritis. Radiol Med. 2019; 124(11):1087-1100. DOI: 10.1007/s11547-019-01002-2. View

13.

Sarzi-Puttini P, Zen M, Arru F, Giorgi V, Choy E . Residual pain in rheumatoid arthritis: Is it a real problem?. Autoimmun Rev. 2023; 22(11):103423. DOI: 10.1016/j.autrev.2023.103423. View

14.

Bandinelli F, Kaloudi O, Candelieri A, Conforti M, Casale R, Cammarata S . Early detection of median nerve syndrome at the carpal tunnel with high-resolution 18 MHz ultrasonography in systemic sclerosis patients. Clin Exp Rheumatol. 2010; 28(5 Suppl 62):S15-8. View

15.

van der Heijde D, van der Helm-van Mil A, Aletaha D, Bingham C, Burmester G, Dougados M . EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria. Ann Rheum Dis. 2013; 72(4):479-81. DOI: 10.1136/annrheumdis-2012-202779. View

16.

Koop S, Ten Klooster P, Vonkeman H, Steunebrink L, van de Laar M . Neuropathic-like pain features and cross-sectional associations in rheumatoid arthritis. Arthritis Res Ther. 2015; 17:237. PMC: 4558794. DOI: 10.1186/s13075-015-0761-8. View

17.

Smolen J, Aletaha D, McInnes I . Rheumatoid arthritis. Lancet. 2016; 388(10055):2023-2038. DOI: 10.1016/S0140-6736(16)30173-8. View

18.

Coraci D, Loreti C, Fusco A, Giovannini S, Padua L . Peripheral Neuropathies Seen by Ultrasound: A Literature Analysis through Lexical Evaluation, Geographical Assessment and Graph Theory. Brain Sci. 2021; 11(1). PMC: 7829799. DOI: 10.3390/brainsci11010113. View

19.

Agarwal V, Singh R, Wiclaf , Chauhan S, Tahlan A, Ahuja C . A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol. 2007; 27(7):841-4. DOI: 10.1007/s10067-007-0804-x. View

20.

Freynhagen R, Tolle T, Gockel U, Baron R . The painDETECT project - far more than a screening tool on neuropathic pain. Curr Med Res Opin. 2016; 32(6):1033-57. DOI: 10.1185/03007995.2016.1157460. View