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Background: Rheumatoid arthritis (RA) is a systemic autoimmune chronic inflammatory condition that may impact a variety of organs and tissues, but mostly targets flexible (synovial) joints. Objective: The aim of the current study was to assess influence of power Doppler ultrasound (PDUS) and high-resolution ultrasonography (US) in estimation of ankle joints abnormalities in patients suffering RA with or without ankle joint pain. Patients and Methods: A cross sectional study was conducted on 100 participants presented with clinical diagnosis of RA, from the Rheumatology and Rehabilitation outpatient clinic of Al-Azhar University Hospitals. Participants were subjected to a comprehensive history, clinical examination by the referral to rheumatologist, laboratory tests, and high-resolution US and PDUS examination. Results: Patients with symptoms had a considerably higher Disease Activity Score in 28 joints (DAS 28) than those without symptoms (P<0.001). Patients without symptoms had a considerably greater prevalence of low DAS 28 scores (P<0.001), but high score was considerably greater in symptomatic individuals (P=0.007). Conclusion: US enables rapid identification and precise detection of joint and/or tendon inflammatory involvement at ankle level in individuals with RA. Clinicians should be recommended to utilize US more often to identify pathological ankle problems. [ABSTRACT FROM AUTHOR]

Abstract Background Evaluation of remission in Rheumatoid Arthritis (RA) largely relies on composite scores based on clinical and laboratory assessments however, patients can fulfill clinical remission criteria as defined by composite scores, yet still have evidence of synovitis detectable on imaging. Aim of the work To evaluate hand and wrist joints in patients with RA in clinical remission using power Doppler (PD) ultrasonography and to study the association between ultrasonographic findings and composite index scores. Patients and methods This study was conducted on 50 RA patients in clinical remission. Ten matched healthy subjects were included as control. The modified health assessment questionnaire (MHAQ) was assessed in the patients; disease activity was calculated using a composite index score including disease activity score (DAS28) and clinical disease activity index (CDAI). Ultrasonographic assessment of the hand and wrist joints was performed. Results The mean age of the patients was 50.9 ± 9.2 years, disease duration was 10.6 ± 5.5 years and were 38 females and 12 males. The mean DAS28 was 2.3 ± 0.3. On ultrasonographic examination, 14 (28%) patients had normal synovium, while 18 (36%) showed synovial hypertrophy without evidence of inflammation and 18 (36%) had PD signals. DAS28 was higher in patients with PD signals (2.36 ± 0.3) compared to those without synovitis (2.3 ± 0.28). There was a significant correlation between PD activity and CDAI (p = 0.005), MHAQ (p = 0.002) and disease duration (p = 0.023). Conclusion Power Doppler ultrasound can detect residual inflammation in RA patients in clinical remission and its scores were signficantly associated with the clinical disease activity index and functional status. [ABSTRACT FROM AUTHOR]

Aim: Comparative evaluation of direct current and steroid iontophoresis treatments in patients with active wrist synovitis with rheumatoid arthritis. Material and Methods: Rheumatoid arthritis (RA) is a chronic, inflammatory disease that causes pain, swelling and limitation of motion, keeping wrist and hand joints symmetrical. In this study, we examined the efficacy of steroid iontophoresis with direct current to the wrists of active RA patients. 20 active patients with RA and wrist synovitis were included in the study. Steroid iontophoresis applied in one wrist of these patients, direct current to the other wrist (control). Patients' number of painful joints (NPJ), number of swollen joints (SJN), hand grip strength (HG), lateral grip strength (LG), Hand Functional Evaluation (HFE), Health Assessment Questionnaire (HAQ), Disease Activity Score-28 (DAS-28) and power Doppler ultrasonography (PDUS) were compared. Results: Clinical and laboratory parameters were significantly improved according to pre-treatment (Pr-T) and post-treatment (Pst-T). We found significant improvement in Pr-T and Pst-T in the cases of HG, LG, HFE, SJN and NPJ in the wrist in treatment and control, but there was no significant difference between the control wrist and the treated wrist. There were no changes in Pr-T and Pst-T in grades, if any, resistive index (RI) and pulsatility index (PI) values of PDUS with pannus and current in hand wrist. Conclusions: Our results showed no difference between the steroid iontophoresis and direct current therapy in patients with RA who were active and have wrist synovitis in Pr-T and Pst-T. [ABSTRACT FROM AUTHOR]

Background & objectives: It has been shown that joint damage due to subclinical synovitis progresses despite apparent clinical remission in rheumatoid arthritis (RA). Hence, finding more objective methods to investigate subclinical synovitis has become a current issue. Ultrasonography (US) has been among the most investigated methods. This study was conducted to detect whether there was subclinical inflammation in RA patients in clinical remission by power Doppler ultrasonography (PDUS) and to evaluate the effects of this inflammation on upper extremity function. Methods: Forty five RA patients fulfilled the remission criteria of disease activity score 28 using erythrocyte sedimentation rate (DAS28-ESR), were enrolled in the study. Bilateral wrist, 2nd and 3th metacarpophalangeal and proximal interphalangeal joints and 2nd and 5th metatarsophalangeal joints were examined by PDUS. Upper extremity function was assessed with Michigan Hand Outcomes Questionnaire (MHQ) and handgrip strength. The pain was evaluated by visual analogue scale (VAS). Results: In 29 of 45 RA patients in clinical remission, synovitis was detected by PDUS at least in one joint. VAS and DAS28-ESR scores were significantly lower and total MHQ, some subgroup scores of MHQ (overall hand function, activity of daily living and work performance) and grip strength of the dominant hand were higher in patients with PD signal negativity. Interpretation & conclusions: PDUS showed a crucial role in determining the subclinical synovitis. Subclinical synovitis negatively affects the upper extremity function. Ultrasound-defined remission may be considered for good functional status and real remission in patients with RA. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Lymph node (LN) in rheumatoid arthritis (RA) has been the focus of recent research work; as it is implicated in disease pathogenesis. Power Doppler ultrasonography (PD-US) is increasingly used for imaging of lymph nodes in conditions other than arthritis. Aim of the work: To assess the axillary LN in RA using PD-US, and to correlate the findings to disease activity. Patients and methods: Fourteen Consecutive RA patients were subjected to clinical examination and PD-US of axillary LNs, metacarpophalangeal joints (MCPJs) and wrist joints of the ipsilateral sides. LNs were assessed for cortex/hilum (CH) area ratio, longitudinal/transverse (LT) axis ratio and PD signal type. Joints were assessed for grey scale (GS) score and PD score. GS and PD signals were assigned to each joint in accordance with semi-quantitative 0–3 scales for each. DAS28 score was used for disease activity assessment. Results: PD-US detected subclinical LN changes in 24/28 of the examined axillae in RA patients. Changes included hypertrophy mainly of the cortical area and amplification of vascularity of the central type. LN changes did not correlate to DAS28 score; rather correlated to GS and PD scores of ipsilateral wrist and MCPJs as assessed by PD-US. Conclusion: PD-US detects subclinical axillary LN changes in RA patients. These changes do not correlate to DAS28. Axillary LN changes associate signs of synovitis in ipsilateral wrist and MCPJs as assessed by PD-US. Owing to the small number of patients enrolled, results presented in this work should be considered preliminary. [Copyright &y& Elsevier]

Objectives: To compare quantitative magnetic resonance imaging (MRI) and power Doppler ultrasonography (PDUS) with conventional measures of disease activity in rheumatoid arthritis (RA) patients treated with the anti-interleukin 6 (anti-IL 6) receptor antibody tocilizumab in terms of responsiveness at a few months to disease activity and ability to predict structural damage at 1 year.Methods: A cohort of patients with RA (n = 29) was evaluated clinically including disease activity score 28 (DAS28) and by semiquantitative (SQ-) and quantitative (Q-) PDUS (bilateral metacarpophalangeal joints) and MRI (one hand and wrist) at initiation of treatment with anti-IL 6 receptor antibody agents and after 2 and 5 months. Conventional radiography for both hands and wrists was performed at baseline and at 12 months. Responsiveness was assessed by standardized response means (SRM). Areas under the curve (AUC) for measures at baseline, 2 and 5 months were correlated with structural damage at 1 year.Results: Among the laboratory and clinical parameters, DAS28-ESR was the most responsive with a large effect size of SRM. Structural damage progressions for radiography and MR erosion were correlated with AUC of MR bone erosion and Q-PDUS, respectively.Conclusions: In the evaluation of disease activity in RA patients in the first few months after starting anti-IL 6 receptor antibody tocilizumab treatment, the semiquantitative MR bone erosion score of the hand and quantitative value for power Doppler signal in the finger joint were both responsive and predictive of structural damage progression at 1 year. [ABSTRACT FROM AUTHOR]

We report a case of rheumatoid arthritis in which the earliest symptom was bilateral paratendonitis of the Achilles tendons, followed by paratendonitis of a finger extensor. A series of musculoskeletal ultrasonograms revealed a progression from paratendonitis of the extensor tendon to erosive synovitis of the adjacent metacarpophalangeal joint. High-resolution ultrasonography combined with power Doppler imaging seems to be a useful and convenient tool both for diagnosing paratendonitis early and for closely monitoring the progressing inflammation. [ABSTRACT FROM AUTHOR]

Power Doppler ultrasonography (PD-US) has proved to be a useful technique to measure synovial vascularity due to its capability to provide data that can be used to evaluate the level of joint inflammation and assess rheumatoid arthritis (RA). We have developed a novel PD-US finger joint scoring method that introduces quantitative measurements into the conventional PD-US assessment method. A comparison of the two methods revealed that our novel PD-US method strongly correlates with the conventional method in terms of RA assessment. We performed finger joint PD-US on 69 patients with RA and 70 patients who had multiple joint pain but showed no evidence of inflammatory diseases (non-inflammatory disease, NI) and measured the synovial vascularity of the metacarpophalangeal joints 1–5 and proximal interphalangeal (PIP) joints 1–5 for each patient. We analyzed the data with receiver operating characteristic analysis and, based on the results for the total vascularity of 20 finger joints, defined a cut-off value of 36% as discriminating between RA and NI. This cut-off value was found to be a valuable tool in screening for RA. We conclude that our finger joint PD-US scoring system is both useful and applicable for diagnosing RA. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterize the pathological conditions of symptomatic ankles in patients with rheumatoid arthritis (RA) using power Doppler sonography (PDS). We analyzed 17 consecutive ultrasonography (US) records of RA patients with symptomatic ankles who underwent B-mode ultrasonography (BUS) combined with PDS of their ankles in our department because of clinical need. Correlations between US findings and clinical and serological data were assessed. The diagnostic capabilities of BUS and PDS were also compared. Common US findings were talocrural synovitis (76%), subtalar synovitis (71%), and talonavicular synovitis (59%). Tenosynovitis around the ankle was detected in ten patients (59%), including several cases of tenosynovitis of tibialis posterior (41%) and tenosynovitis of peroneus longus and brevis (35%). Achilles tendon enthesitis was detected in six patients, and retrocalcaneal bursitis was detected in five. Compared with BUS, PDS offers demonstrably superior diagnostic capability for the detection of rheumatoid ankle diseases, especially subtalar joint synovitis and peroneal tenosynovitis. Rheumatoid factor (RF) levels were significantly higher in patients with tenosynovitis than in patients without tenosynovitis. PDS is an excellent modality for diagnosing both intra- and extracapsular synovitis in rheumatoid ankles. Using PDS, we found positive association between ankle tenosynovitis and RF levels in RA patients. [ABSTRACT FROM AUTHOR]

Objective: To compare three-dimensional (3D) power Doppler ultrasonography (PDUS) with contrast enhanced magnetic resonance imaging (MRI) in their capability to visualize synovial vascularity in inflamed wrists of patients with rheumatoid arthritis (RA).Methods: Nine patients with RA showing clinically active arthritis of the wrist as determined by tenderness and swelling were examined by contrast enhanced MRI and 3D PDUS. Vascularity close to and inside the joint capsule was visualized by conventional power Doppler mode. In a region with high Doppler signal intensity (=region of interest/ROI) a 3D blood vessel tree was obtained by a free-hand sweep. 3D images were evaluated with regard to the number of blood vessels in the intra- and peri-articular region. MRI examinations were performed using a 1.5 T Scanner. In MRI, time resolved coronal contrast enhanced T1-weighted sequences with fat suppression were acquired during an 8 min period to assess tissue enhancement. Relative enhancement was calculated and compared to 3D PDUS findings.Results: A 3D vascular tree consisting of peri- and intra-articular blood vessels could be demonstrated in the same anatomical ROI in which an increased gadolinium enhancement was measured by MRI in all examined RA patients. The number of penetrating vessels into the joint capsule, the number of intra-articular vessels and a semiquantitative estimation of the strength of blood flow were used to generate a 3D score for the intensity of synovial vascularity.Conclusion: When compared with clinical symptoms and the gold standard dynamic MRI, 3D PDUS is a reliable imaging technique for assessing synovial vascularity in inflamed wrists of RA patients. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Comparer l''échographie-doppler de puissance à trois dimensions (EDP3D) et l''imagerie par résonance magnétique avec injection de contraste (IRM) pour visualiser la vascularisation synoviale dans le poignet rhumatoïde. Méthodes: Les deux examens d''imagerie ont été réalisés chez neuf malades qui souffraient de polyarthrite rhumatoïde responsable au poignet de douleurs et d''une tuméfaction. La vascularisation intra- et péricapsulaire a été visualisée par doppler de puissance classique. Une région d''intérêt (RI) caractérisée par un signal doppler de forte intensité a été sélectionnée. Dans cette région, l''arbre vasculaire a été visualisé en 3D grâce à un balayage à main libre. Le nombre de vaisseaux dans les régions intra- et péricapsulaires sur les images en 3D a été déterminé. Une IRM avec injection de contraste a été réalisée avec un appareil de 1,5 Tesla. Des coupes frontales en résolution de temps, pondérées en T1, ont été obtenues au cours d''une période de huit minutes afin d''évaluer la prise de contraste tissulaire. La prise de contraste relative a été calculée et comparée aux résultats de l''EDP3D. Résultats: Chez tous les malades, l''EDP3D a permis de visualiser un arbre vasculaire comportant des vaisseaux intra- et périarticulaires dans la région de prise de contraste en IRM. Nous avons déterminé un score 3D de vascularisation synoviale à partir du nombre de vaisseaux qui pénétraient dans la capsule, du nombre de vaisseaux intra-articulaires et d''une estimation semi quantitative du débit sanguin. Conclusion: Par comparaison aux manifestations cliniques et à l''IRM dynamique, qui constitue la technique de référence, l''EDP3D permet une évaluation fiable de la vascularisation synoviale du poignet rhumatoïde. [Copyright &y& Elsevier]