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Cinar C, Dogan YE, Harman H, Yurttutmus Z, Bagatir N, Doran M, Öneş K. Comparison of Hand-Wrist Findings of Rheumatoid Arthritis Patients According to the Use of Synthetic and Biological Disease-Modifying Antirheumatic Drugs (DMARDs): A Clinical, Radiographic, and Ultrasonographic Study. Cureus 2023; 15:e46876. [PMID: 37954693 PMCID: PMC10638456 DOI: 10.7759/cureus.46876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the hand-wrist findings in patients with rheumatoid arthritis (RA) using synthetic and a combination of synthetic and biological disease-modifying antirheumatic drugs (DMARDs) in terms of ultrasonographic, clinical, and radiographic data. METHODS The study is designed as a cross-sectional study, and 31 RA patients followed up in the rheumatology outpatient clinic were enrolled. Nineteen patients were using only synthetic DMARDs, and 12 patients were using a combination of synthetic and biological DMARDs. The clinical data of each patient were recorded simultaneously. Disease Activity Score-28 (DAS-28) was used for the assessment of disease activation, and the Health Assessment Questionnaire (HAQ) score was used for the evaluation of general health status. Bilateral proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints, and the radiocarpal, ulnocarpal, and midcarpal joints of the patients were examined by ultrasonography (US). The Sharp-van der Heijde modified score was used to determine the radiographic damage. RESULTS There was no significant difference between the two groups in terms of demographic data, clinical findings, ESR, and CRP. When the groups were compared in terms of right and left PIP, MCP, and radiocarpal, ulnocarpal, and midcarpal synovitis grade total scores, no significant difference was found between the two groups. Radiographic total joint space scores were significantly lower in the group receiving only synthetic DMARD treatment (p=0.047) and 25-OH vitamin D levels were significantly higher (p=0.008). CONCLUSION This study revealed that there was no significant difference between groups except radiographic total joint space scores.
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Affiliation(s)
- Cigdem Cinar
- Department of Interventional Physiatry, Biruni University, Istanbul, TUR
| | - Yunus Emre Dogan
- Department of Physiotherapy, Istanbul Physical Therapy and Rehabilitation Health Application and Research Center, Istanbul, TUR
| | - Halil Harman
- Department of Rheumatology, Kanuni Sultan Suleyman Health Application and Research Center, Istanbul, TUR
| | - Zeynep Yurttutmus
- Department of Physiotherapy, Istanbul Physical Therapy and Rehabilitation Health Application and Research Center, Istanbul, TUR
| | - Nazire Bagatir
- Department of Physiotherapy, Istanbul Physical Therapy and Rehabilitation Health Application and Research Center, Istanbul, TUR
| | - Muhsin Doran
- Department of Physiotherapy, Yalvac Public Hospital, Istanbul, TUR
| | - Kadriye Öneş
- Department of Physiotherapy, Istanbul Physical Therapy and Rehabilitation Health Application and Research Center, İstanbul, TUR
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Smith E, Azzopardi C, Thaker S, Botchu R, Gupta H. Power Doppler in musculoskeletal ultrasound: uses, pitfalls and principles to overcome its shortcomings. J Ultrasound 2020; 24:151-156. [PMID: 32683646 DOI: 10.1007/s40477-020-00489-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022] Open
Abstract
Power Doppler (PD) is used widely in musculoskeletal ultrasound, especially in the assessment of structures for evidence of inflammation and in evaluating soft tissue neoplasms. We reinforce and delineate the three cardinal principles of optimising PD assessment in order to avoid false positive or false negative results; namely (1) Optimal gain settings (2) Adequate transducer pressure, and (3) Proper patient/anatomical structure-of-interest positioning with complete tissue relaxation.
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Affiliation(s)
- E Smith
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - S Thaker
- Department of Radiology, Kettering General Hospital, Kettering, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
| | - H Gupta
- Department of Musculoskeletal Imaging, Leeds Teaching Hospital, Leeds, UK
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Fawzy RM, Said EA, Mansour AI. Association of neutrophil to lymphocyte ratio with disease activity indices and musculoskeletal ultrasound findings in recent onset rheumatoid arthritis patients. EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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The Role of Power Doppler Ultrasonography as Disease Activity Marker in Rheumatoid Arthritis. DISEASE MARKERS 2015; 2015:325909. [PMID: 26063952 PMCID: PMC4433665 DOI: 10.1155/2015/325909] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/07/2015] [Indexed: 11/28/2022]
Abstract
Structural damage in rheumatoid arthritis (RA) occurs early if inflammation is not treated promptly. Treatment targeted to reduce inflammation, in particular, that of synovial inflammation in the joints (synovitis), has been recommended as standard treat-to-target recommendations by rheumatologists. The goal is to achieve disease remission (i.e., no disease activity). Several accepted remission criteria have not always equated to the complete absence of true inflammation. Over the last decade, musculoskeletal ultrasonography has been demonstrated to detect subclinical synovitis not appreciated by routine clinical or laboratory assessments, with the Power Doppler modality allowing clinicians to more readily appreciate true inflammation. Thus, targeting therapy to Power Doppler activity may provide superior outcomes compared with treating to clinical targets alone, making it an attractive marker of disease activity in RA. However, more validation on its true benefits such as its benefits to patients in regard to patient related outcomes and issues with standardized training in acquisition and interpretation of power Doppler findings are required.
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Harman H, Tekeoğlu İ, Takçı S, Kamanlı A, Nas K, Harman S. Improvement of large-joint ultrasonographic synovitis is delayed in patients with newly diagnosed rheumatoid arthritis: results of a 12-month clinical and ultrasonographic follow-up study of a local cohort. Clin Rheumatol 2015; 34:1367-74. [DOI: 10.1007/s10067-015-2926-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/10/2015] [Accepted: 03/20/2015] [Indexed: 11/24/2022]
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Zheng G, Wang L, Jia X, Li F, Yan Y, Yu Z, Li L, Wei Q, Zhang F. Application of high frequency color Doppler ultrasound in the monitoring of rheumatoid arthritis treatment. Exp Ther Med 2014; 8:1807-1812. [PMID: 25371736 PMCID: PMC4218660 DOI: 10.3892/etm.2014.2001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/29/2014] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to explore the use of high frequency color Doppler ultrasound to measure synovial thickness and blood flow to assess the therapeutic value of the recombinant human tumor necrosis factor (TNF) II receptor antibody fusion protein in rheumatoid arthritis (RA) treatment. A total of 36 clinically-diagnosed patients with RA were treated with methotrexate tablets or the recombinant TNF-receptor antibody fusion protein for 24 weeks. Joint synovial thickness and synovial blood flow integrity were monitored by high frequency color Doppler in the second metacarpophalangeal joint in one hand. The correlation of the erythrocyte sedimentation rate, C-reactive protein (CRP) and 28-joint disease activity score (DAS28) with the ultrasound parameters were analyzed. Metacarpophalangeal second joint 2 (MCP2) synovial thickness, wrist joint synovial thickness and MCP2 synovial blood flow, prior and subsequent to the treatment, have a high correlation with DAS28 (P<0.05), and the MCP2 synovial blood flow integral has a strong correlation with CRP. Evaluating the wrist joint synovial thickness and synovial integrity of the second metacarpophalangeal joint using high frequency ultrasound detection can effectively evaluate the disease status in patients with RA. This procedure is potentially valuable as a means of evaluating the curative effects of RA treatments.
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Affiliation(s)
- Guimin Zheng
- Department of Rheumatology, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Lei Wang
- Department of Medicine Imaging, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Xiuchuan Jia
- Department of Medicine Imaging, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Fang Li
- Department of Rheumatology, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Yonglong Yan
- Department of Rheumatology, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Zhibo Yu
- Department of Rheumatology, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Li Li
- Department of Ultrasound Imaging, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Qun Wei
- Department of Nosocomial Infection Control, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Fengxiao Zhang
- Department of Rheumatology, Hebei Province General Hospital, Shijiazhuang, Hebei 050051, P.R. China
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Ultrasonography is useful to detect subclinical synovitis in SLE patients without musculoskeletal involvement before symptoms appear. Clin Rheumatol 2014; 33:341-8. [PMID: 24478125 DOI: 10.1007/s10067-014-2502-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 12/11/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this study is to investigate the frequency of the subclinical synovitis in hand or wrist joints of the SLE patients using ultrasonography (US) and to correlate them with clinical parameters. Forty-eight systemic lupus erythematosus (SLE) patients without musculoskeletal (MS) involvement were enrolled and underwent clinical and laboratory examinations. Gray-scale and power Doppler (PD) US was performed for imaging the wrist, second and third metacarpophalangeal (MCP) joints, and flexor tendons on non-dominant sides of the individuals. US synovitis index (USSI) and PD index were calculated as sum of the synovitis and PD semiquantitative scores, respectively, obtained from each joint. Subclinical synovitis was found by US in 28 (58.3%) out of 48 patients. US revealed synovitis of the wrist in 16 (33.3%) patients, of the second MCP joint in 14 (29.2%) and of the third MCP joint in 15 (31.3%). PD signals in three (6.3%) patients and tenosynovitis in two (4.2%) were also detected. USSI scores showed significant positive correlation with erythrocyte sedimentation rate (ESR) levels (r = 0.30, p < 0.05) or anti-dsDNA Ab titers (r = 0.34, p < 0.05). Within 6 months after US examination, new MS symptoms were developed in 11 (22.9%) patients. Older age at diagnosis (OR 1.283, 95% CI 1.029-1.601, p = 0.027) or higher USSI scores (OR 12.93, 95% CI 1.023-163.503, p = 0.048) were independently associated with development of new MS symptoms. Subclinical synovitis is common in SLE patients who do not suffer from MS symptoms. US is useful to detect joint abnormalities before symptoms appear in SLE patients.
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Chakr RMDS, Mendonça JA, Brenol CV, Xavier RM, Brenol JCT. Assessing rheumatoid arthritis disease activity with ultrasound. Clin Rheumatol 2013; 32:1249-54. [PMID: 23700041 DOI: 10.1007/s10067-013-2291-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/13/2013] [Indexed: 01/19/2023]
Abstract
In practice, composite indices are used for rheumatoid arthritis (RA) disease activity evaluation. Despite valid and widely used, not rarely composite indices miss accuracy. Ultrasound (US) is more precise than clinical examination in synovitis appraisal. US-based disease activity estimation depends on the detection of synovitis. The most common synovitis abnormalities are proliferation, effusion, and neoangiogenesis. Gray scale ultrasound identifies synovial hypertrophy and effusion with its good soft tissue contrast. Additionally, power Doppler ultrasound depicts neoangiogenesis within synovia, remarking local inflammation. Several studies have combined local US findings to develop a patient level disease activity index. Most of them summed selected joint scores in an overall score of disease activity and evaluated its correlation with clinical composite indexes. To be incorporated into clinical practice, an overall US score must have some fundamental characteristics such as reproducibility, viability, and sensitivity to change over time. In global US score development, finding the joints that truly estimate individual disease activity is highly challenging. This article presents an up-to-date literature review on assessing RA disease activity with US and depicts the challenges in finding the perfect global US score.
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Affiliation(s)
- Rafael Mendonça da Silva Chakr
- Rheumatology Division Faculty, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, suite 645, Porto Alegre, Rio Grande do Sul, CEP 90035-903, Brazil.
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McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M, Bannuru RR, Srinivasan S, Gogia M, McMahon MA, Grossman J, Kafaja S, FitzGerald J. American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken) 2013; 64:1625-40. [PMID: 23111854 DOI: 10.1002/acr.21836] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Tan YK, Conaghan PG. Imaging in rheumatoid arthritis. Best Pract Res Clin Rheumatol 2012; 25:569-84. [PMID: 22137925 DOI: 10.1016/j.berh.2011.10.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 09/10/2011] [Indexed: 01/29/2023]
Abstract
The optimal management of rheumatoid arthritis (RA) requires tools that allow early and accurate disease diagnosis, prediction of poor prognosis and responsive monitoring of therapeutic outcomes. Conventional radiography has been widely used in both clinical and research settings to assess RA joint damage due to its feasibility, but it has limitations in early disease detection and difficulty distinguishing between active treatments in modern trials. Imaging modalities such as magnetic resonance imaging (MRI) and ultrasound (US) have the advantage of detecting both joint inflammation and damage and hence they can provide additional and unique information. This can be especially useful in the context of early and/or undifferentiated joint disease when detection of soft tissue and bone marrow abnormalities is desirable. This review focusses on the recent literature concerning modern imaging, and provides clinicians with an insight into the role of imaging in modern RA diagnosis, prognosis and monitoring.
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Affiliation(s)
- York Kiat Tan
- Division of Musculoskeletal Disease, University of Leeds, UK
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Porta F, Radunovic G, Vlad V, Micu MC, Nestorova R, Petranova T, Iagnocco A. The role of Doppler ultrasound in rheumatic diseases. Rheumatology (Oxford) 2012; 51:976-82. [PMID: 22253027 DOI: 10.1093/rheumatology/ker433] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The use of Doppler techniques, including power, colour and spectral Doppler, has greatly increased in rheumatology in recent years. This is due to the ability of Doppler US (DUS) to detect pathological vascularization within joints and periarticular soft tissues, thereby demonstrating the presence of active inflammation, which has been reported to be correlated with the local neo-angiogenesis. In synovitis, DUS showed a high correlation with histological and MRI findings, thus it is considered a valid tool to detect pathological synovial vascularization. Moreover, it is more sensitive than clinical examination in detecting active joint inflammation and in the evaluation of response to treatment. In addition, DUS may be considered as a reference imaging modality in the assessment of enthesitis, MRI being not sensitive and histology not feasible. Moreover, it has been demonstrated to be able to detect changes in asymptomatic enthesis. In conclusion, DUS is a useful and sensitive tool in the evaluation and monitoring of active inflammation. Its widespread use in clinical rheumatological practice is recommended. The aim of this article is to review the current literature about the role of DUS in rheumatic diseases, analysing its validity, reliability and feasibility.
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Affiliation(s)
- Francesco Porta
- Dipartimento Medicina Interna e Specialità Mediche: Reumatologia, Sapienza Università di Roma, V. le del Policlinico 155, Rome 00161, Italy
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Quantitative analysis of vascularization in the finger joints in patients with rheumatoid arthritis using three-dimensional volumetric ultrasonography with power Doppler. Clin Rheumatol 2011; 31:299-307. [DOI: 10.1007/s10067-011-1811-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/30/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
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Schirmer M, Duftner C, Schmidt WA, Dejaco C. Ultrasonography in inflammatory rheumatic disease: an overview. Nat Rev Rheumatol 2011; 7:479-88. [DOI: 10.1038/nrrheum.2011.95] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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