Role of High-Resolution Grey Scale and Power Doppler Ultrasonography in the Evaluation of Synovial Activity of Wrist and Hand Joints in Rheumatoid Arthritis

Document Type : Original Article

Authors

1 Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt

2 Diagnostic and Interventional Radiology Department, Ain Shams University Hospitals, in Cairo, Egypt.

10.21608/asmj.2024.309351.1292

Abstract

Background: Ultrasound is well established for diagnosis of Rheumatoid Arthritis (RA); it enhances clinical examination by early detection and identifying true remission.
Aim of the Work: Evaluate the efficacy of ultrasound and power Doppler in diagnosing and evaluating the activity of RA compared to serology & DAS28 scoring system.
Patients and Methods: Cross-sectional study involved 53 patients diagnosed with RA. Joints were evaluated by Ultrasound for synovial thickening, effusion, bony erosions and increased Doppler activity. Patients underwent serological assessment for (RF), CRP, ESR, and anti-CCP levels. DAS28 scoring system was also applied for each patient.
Results: Ultrasound detected synovial thickening in 100%, synovial effusion in 60.4%, bony erosions in 26.4 % & increased Doppler activity in 84.9 % of patients. Positive RF test in 47.2 % of cases, Positive anti-CCP test in 81.1%, elevated ESR level in 84.9%, and elevated CRP level in 100% of cases. According to DAS 28 score, 50.9% of patients had low to moderate disease activity while 49.1% had severe disease activity. RF had significant correlation with synovial thickening in 2 joints and joint effusion in 2 joints. Anti-CCP had significant correlation with joint effusion and power Doppler activity in 1 joint. ESR had significant correlation with synovial thickening in 3 joints and with joint effusion in 2 joints. CRP had significant correlation with synovial thickening in 10 joints, with joint effusion in 11 joints, with power Doppler activity in 5 joints and with bony erosions in 1 joint. DAS 28-scoring system had significant correlation with synovial thickening in 5 joints and with power Doppler activity in 5 joints.
Conclusion: US has better diagnostic value compared to clinical and laboratory assessment of RA, it can assess both soft tissue and erosive joint changes that occur in RA and differentiate between inactive and active synovial hypertrophy by using power Doppler signal.

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