Joint involvement in Rheumatoid arthritis: Sonographic evaluation in comparison with Radiography

Sharanayya ., Shamrendra Narayan, Vandana Verma, Madhu Sharma, Anjana Pande, Vivek Jirankali


Background: The aim of this study was to evaluate the role of ultrasonography (including power doppler) in assessing the joint involvement in Rheumatoid Arthritis (RA) and its comparison to radiographic changes.
Materials and Methods: 55 patients with RA underwent ultrasound and radiographic examination of wrist and hand with laboratory investigations. 25 subjects were taken as controls. Following points were specifically looked in ultrasound – synovitis, synovial hypertrophy, effusion, cartilage thickness, swelling of tendon, osteophytes, erosions. Erosion sites were compared using radiographs. Ultrasonography was performed by two radiologists and inter-observer agreement was calculated.
Results: Out of total 55 cases, 44 cases were classified as early RA and 11 cases as advanced RA. Out of 25 control subjects, 3 subjects had a lesion – atypical for RA, however – all 3 had previous trauma at that site. Inter-observer agreement was excellent. Intra-articular erosions were seen in all cases of advanced RA and in only 26/44 cases in early RA cases. Tenosynovitis was seen in 21/44 cases of early RA while only one case of advanced RA showed tenosynovitis. There was reduced cartilage thickness in all patients of advanced RA while none was observed in early RA cases. Synovial hypertrophy and synovial effusion were almost similar in both early and advanced RA cases. Ultrasonography detected erosions in 37/54 cases while radiography detected erosions in only 11/54 cases.
Conclusions: Sonography can be used as a primary modality to diagnose RA especially early RA, which helps in reducing disabilities by early aggressive treatment. It is more sensitive than radiography in detecting erosions.

Keywords: Erosions, Ultrasonography, Radiograph, Synovitis.

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