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Guillén-Astete CA, Revenga-Martínez M, Zea-Mendoza AC, Brito-Brito ME, Zurita-Prada P, Urrego-Laurín C, Villalobos-Sánchez L, García-Montes N, Vázquez-Díaz M. Subclinical synovitis impact on the progression of lupus joint disease: A 10-year longitudinal multicenter study. Lupus 2024; 33:638-643. [PMID: 38491423 DOI: 10.1177/09612033241240584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To determine the effect of subclinical synovitis on the progression of joint disease in a cohort of patients with systemic lupus erythematosus over a mean follow-up of 10 years. METHODS A longitudinal follow-up of 96 patients diagnosed with lupus was performed. All patients were considered clinically free of joint disease or with minimal joint impairment at baseline and were studied through ultrasound study of their dominant hand to assess the prevalence of subclinical synovitis. Now, over 10 years after we contacted them and reviewed their evolution to determine the impact of had or had not been diagnosed with subclinical synovitis in their current joint condition. RESULTS Thirty-one of the 91 reached patients developed clinical progression in their joint manifestations (at least one ordinal degree of worsening). Of these, 23 (74,9%) had demonstrated subclinical synovitis at baseline. In the group of patients who did not progress clinically, 46 (76,6%) did not have this finding at the start of follow-up (p < .01, OR 9,44 95%CI 3,46-25,74). The patients in whom clinical progression was demonstrated had worse combined ultrasound scores than the rest of the patients: 6,41 SD 1,45 vs. 1,15 SD 0,97 (p < .01). CONCLUSIONS The finding of subclinical synovitis in patients with systemic lupus erythematosus is associated with the development of joint disease progression both clinically and ultrasonographically.
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Affiliation(s)
- Carlos A Guillén-Astete
- Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain
- Faculty of Biomedical Sciences and Health, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
- Rheumatology Unit, HLA Moncloa University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - Nuria García-Montes
- Family and Community Medicine, Urgency & Emergency Department, Ramón y Cajal University Hospital, Madrid, Spain
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Corzo Garcia P, Garcia-Duitama I, Agustí Claramunt A, Duran Jordà X, Monfort J, Salman-Monte TC. Musculoskeletal involvement in systemic lupus erythematosus: a contrast-enhanced magnetic resonance imaging study in 107 subjects. Rheumatology (Oxford) 2024; 63:423-429. [PMID: 37208172 DOI: 10.1093/rheumatology/kead223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE Joint involvement in SLE is the most frequent manifestation and shows a wide heterogeneity. It has not a valid classification and it is often underestimated. Subclinical inflammatory musculoskeletal involvement is not well known. We aim to describe the prevalence of joint and tendon involvement in hand and wrist of SLE patients, either with clinical arthritis, arthralgia or asymptomatic and compare it with healthy subjects using contrasted MRI. METHODS SLE patients fulfilling SLICC criteria were recruited and classified as follows: group (G) 1: hand/wrist arthritis, G2: hand/wrist arthralgia, G3: no hand/wrist symptoms. Jaccoud arthropathy, CCPa and RF positivity, hand OA or surgery were excluded. Healthy subjects (HS) were recruited as controls: G4. Contrasted MRI of non-dominant hand/wrist was performed. Images were evaluated following RAMRIS criteria extended to PIP, Tenosynovitis score for RA and peritendonitis from PsAMRIS. Groups were statistically compared. RESULTS A total of 107 subjects were recruited (G1: 31, G2:31, G3:21, G4:24). Any lesion: SLE patients 74.7%, HS 41.67%; P 0.002. Synovitis: G1: 64.52%, G2: 51.61%, G3: 45%, G4: 20.83%; P 0.013. Erosions: G1: 29.03%; G2: 54.84%, G3: 47.62%; G4: 25%; P 0.066. Bone marrow oedema: G1: 29.03%, G2: 22.58%, G3: 19.05%, G4: 0.0%; P 0.046. Tenosynovitis: G1: 38.71%; G2: 25.81%, G3: 14.29%, G4: 0.0%; P 0.005. Peritendonitis: G1: 12.90%; G2: 3.23%, G3: 0.0%, G4: 0.0%; P 0.07. CONCLUSION SLE patients have a high prevalence of inflammatory musculoskeletal alterations confirmed by contrasted MRI, even if asymptomatic. Not only tenosynovitis but peritendonitis is also present.
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Affiliation(s)
| | - Ivan Garcia-Duitama
- Musculoskeletal Radiology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Anna Agustí Claramunt
- Musculoskeletal Radiology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | | | - Jordi Monfort
- Rheumatology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
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Song Y, Kirsch G, Jarjour W. The Utility of Ultrasound in Evaluating Joint Pain in Systemic Lupus Erythematosus: Looking beyond Fibromyalgia. J Pers Med 2023; 13:jpm13050763. [PMID: 37240932 DOI: 10.3390/jpm13050763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a complex autoimmune condition with varied clinical presentations, and musculoskeletal pain is one of the most commonly associated symptoms. However, fibromyalgia (FM) is a prevalent co-existing condition in SLE patients that can also cause widespread pain, and in patients with both conditions, it is often difficult to distinguish the underlying cause of musculoskeletal pain and provide optimal therapy. METHODS A retrospective cohort study was conducted including all adult SLE patients who received musculoskeletal ultrasound (US) examinations for joint pain at the Ohio State University Wexner Medical Center between 1 July 2012, and 30 June 2022. Binary and multiple logistic regression analyses were performed to determine predictors of US-detected inflammatory arthritis as well as improved musculoskeletal pain. RESULTS A total of 31 of 72 SLE patients (43.1%) had a co-existing diagnosis of FM. In binary logistic regression, a co-existing diagnosis of FM was not significantly associated with US-detected inflammatory arthritis. In multiple logistic regression analysis, clinically detected synovitis was significantly associated with US-detected inflammatory arthritis (aOR, 142.35, p < 0.01), and there was also a weak association with erythrocyte sedimentation rate (ESR) (aOR 1.04, p = 0.05). In separate multiple logistic regression analysis, US-guided intra-articular steroid injection was the only predictor of improved joint pain at follow-up visit (aOR 18.43, p < 0.001). CONCLUSIONS Musculoskeletal US can be an effective modality to detect inflammatory arthritis as well as to guide targeted intra-articular steroid injection to alleviate joint pain in SLE patients with or without FM.
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Affiliation(s)
- Yeohan Song
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Gabriel Kirsch
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Wael Jarjour
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Smiljanic Tomicevic L, Hocevar A, Sukara G, Cubelic D, Mayer M. The frequency and characteristics of ultrasonographic ankle joint involvement in systemic lupus erythematosus: A prospective cross-sectional single-center study. Medicine (Baltimore) 2022; 101:e29196. [PMID: 35945784 PMCID: PMC9351871 DOI: 10.1097/md.0000000000029196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the ankle joint and tendon involvement in SLE using ultrasound (US) as an imaging modality. Sixty consecutive patients with SLE underwent a detailed clinical evaluation and US examination. Gray-scale and power Doppler US of the bilateral tibiotalar (TT) joints, subtalar (ST) joints, and ankle tendons were performed using a multiplanar scanning technique. Joint effusion, synovitis, tenosynovitis, enthesitis, and vascularization were assessed according to the OMERACT recommendations. The Total Ankle Ultrasound Score (TAUSS) was calculated as the sum of the grades of joint effusion and synovial hypertrophy for both TT and ST joints bilaterally (ranging from 0-24) and power Doppler activity was assessed separately. Finally, US findings were correlated with physical evaluation, laboratory parameters, and SLE activity scores. US ankle joint involvement was present in 32/60 (53.3%) patients. TT joints were affected in 26 (43.3%) and ST joints in 16 (26.7%) patients. Thirteen (21.7%) patients had US tendons and/or enthesal involvement. TT joint effusion was the most frequent finding, present in 55/240 (22.9%) examined joints, followed by synovial hypertrophy detected in 18/240 (7.5%) joints. The median (interquartile range; range) TAUSS of the US-affected joints was 1 (0-2; range 1-10). There were no significant correlations between US findings and inflammatory parameters or serological parameters of disease activity, but we found a weak positive correlation between TAUSS and the European Consensus Lupus Activity Measurement (r = 0.281, P = .029). This study revealed a high prevalence of pathological US ankle changes in patients with SLE and a positive correlation between ankle US involvement and disease activity score (European Consensus Lupus Activity Measurement).
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Affiliation(s)
- Ljiljana Smiljanic Tomicevic
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- *Correspondence: Ljiljana Smiljanic Tomicevic, Kišpatićeva 12, 10000 Zagreb, Croatia (e-mail: ). , , ,
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Goran Sukara
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darija Cubelic
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miroslav Mayer
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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Greenan-Barrett J, Doolan G, Shah D, Virdee S, Robinson GA, Choida V, Gak N, de Gruijter N, Rosser E, Al-Obaidi M, Leandro M, Zandi MS, Pepper RJ, Salama A, Jury EC, Ciurtin C. Biomarkers Associated with Organ-Specific Involvement in Juvenile Systemic Lupus Erythematosus. Int J Mol Sci 2021; 22:7619. [PMID: 34299237 PMCID: PMC8306911 DOI: 10.3390/ijms22147619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
Juvenile systemic lupus erythematosus (JSLE) is characterised by onset before 18 years of age and more severe disease phenotype, increased morbidity and mortality compared to adult-onset SLE. Management strategies in JSLE rely heavily on evidence derived from adult-onset SLE studies; therefore, identifying biomarkers associated with the disease pathogenesis and reflecting particularities of JSLE clinical phenotype holds promise for better patient management and improved outcomes. This narrative review summarises the evidence related to various traditional and novel biomarkers that have shown a promising role in identifying and predicting specific organ involvement in JSLE and appraises the evidence regarding their clinical utility, focusing in particular on renal biomarkers, while also emphasising the research into cardiovascular, haematological, neurological, skin and joint disease-related JSLE biomarkers, as well as genetic biomarkers with potential clinical applications.
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Affiliation(s)
- James Greenan-Barrett
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Georgia Doolan
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Devina Shah
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Simrun Virdee
- Department of Ophthalmology, Royal Free Hospital, London NW3 2QG, UK;
| | - George A. Robinson
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Varvara Choida
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Nataliya Gak
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London NW1 2BU, UK; (N.G.); (M.L.)
| | - Nina de Gruijter
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Elizabeth Rosser
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
| | - Muthana Al-Obaidi
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London WC1N 3JH, UK;
- NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Maria Leandro
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London NW1 2BU, UK; (N.G.); (M.L.)
- Centre for Rheumatology, Division of Medicine, University College London, London WC1E 6DH, UK;
| | - Michael S. Zandi
- Department of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK;
| | - Ruth J. Pepper
- Department of Renal Medicine, Royal Free Hospital, University College London, London NW3 2QG, UK; (R.J.P.); (A.S.)
| | - Alan Salama
- Department of Renal Medicine, Royal Free Hospital, University College London, London NW3 2QG, UK; (R.J.P.); (A.S.)
| | - Elizabeth C. Jury
- Centre for Rheumatology, Division of Medicine, University College London, London WC1E 6DH, UK;
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London WC1E 6DH, UK; (J.G.-B.); (G.D.); (D.S.); (G.A.R.); (V.C.); (N.d.G.); (E.R.)
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London NW1 2BU, UK; (N.G.); (M.L.)
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Guillén-Astete CA, Revenga-Martinez M, Zea-Mendoza A, Brito-Brito E. Prevalence of subclinical synovitis of the hand in patients with systemic lupus erythematosus. Lupus 2020; 29:1423-1429. [PMID: 32741303 DOI: 10.1177/0961203320947149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the prevalence of subclinical synovitis in Lupus patients without peripheral joint symptoms, in those with arthralgias without arthritis and those with episodic arthritis but without radiological structural damage. METHODS We conducted a multicentre cross-sectional study. Patients with lupus from those three categories were recruited to take part in a greyscale ultrasound scan performed by an expert blinded rheumatologist. Data from a historical control group from a previous study was also included for comparisons. Images were assessed separately in order to determine the presence and level of synovitis following Eular recommendations. RESULTS Ninety-six patients (88.5% female) with an average age of 40 ± 6.2 years old, were included. SLICC/ACR score was 0.6 ± 0.3 in the group without joint symptoms (group 0), 0.8 ± 0.3 in the group with arthralgias (group I) and 1.1 ± 0.4 in the group with episodic arthritis. The global prevalence of subclinical synovitis was 38.5%. In group 0, that prevalence was 30%. The time since onset of symptoms of patients with subclinical synovitis was longer than the rest of the patients (9.4 ± 2.2 vs 6.5 ± 4.0 years, P < 0.001). No other remarkable association was founded with clinical features of the disease. CONCLUSIONS This is the first study focused on subclinical synovitis in patients with lupus. Other previous studies had included patients with different levels of arthropathy. Subclinical synovitis does exist in lupus patients in over a third of patients. Its meaning remains unclear and must be a topic of further studies.
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Affiliation(s)
| | | | | | - Elia Brito-Brito
- Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain
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7
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Mo YQ, Yang ZH, Wang JW, Li QH, Du XY, Huizinga TW, Matthijssen XME, Shi GZ, Shen J, Dai L. The value of MRI examination on bilateral hands including proximal interphalangeal joints for disease assessment in patients with early rheumatoid arthritis: a cross-sectional cohort study. Arthritis Res Ther 2019; 21:279. [PMID: 31829263 PMCID: PMC6907274 DOI: 10.1186/s13075-019-2061-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/12/2019] [Indexed: 02/05/2023] Open
Abstract
Background Bilateral hands including proximal interphalangeal joints (PIPJs) are recommended on physical, X-ray radiographic, or ultrasonographic examination by clinical guidelines of rheumatoid arthritis (RA), but MRI still tends to examine unilateral wrists and/or MCPJs. We aimed to demonstrate the advantages of MRI examination on bilateral hands including PIPJs for disease assessment in early RA patients. Methods Active early RA patients received 3.0T whole-body MRI examination with contrast-enhanced imaging on bilateral wrists, MCPJs, and PIPJs. MRI features were scored referring to the updated RAMRIS. Clinical assessments were conducted on the day of MRI examination. Results The mean time of MRI examination was 24 ± 3 min. MRI bone erosion in MCPJs would be missed-diagnosed in 23% of patients if non-dominant MCPJs were scanned unilaterally, while osteitis in MCPJs would be missed-diagnosed in 16% of patients if dominant MCPJs were scanned unilaterally. MRI synovitis severity was also asymmetric: 21% of patients showing severe synovitis unilaterally in non-dominant MCPJs/PIPJs and other 20% showing severe synovitis unilaterally in dominant MCPJs/PIPJs. Among these early RA patients, MRI tenosynovitis occurred the most frequently in wrist extensor compartment I, while MRI examination on bilateral hands demonstrated no overuse influence present. However, overuse should be considered in dominant PIPJ2, PIPJ4, and IPJ of thumb of which MRI tenosynovitis prevalence was respectively 18%, 17%, or 16% higher than the non-dominant counterparts. Early MRI abnormality of nervus medianus secondary to severe tenosynovitis occurred either in dominant or non-dominant wrists; MRI of unilateral hands would take a risk of missed-diagnosis. Common MRI findings in PIPJs were synovitis and tenosynovitis, respectively in 87% and 69% of patients. MRI tenosynovitis prevalence in IPJ of thumb or PIPJ5 was much higher than the continued wrist flexor compartments. MRI synovitis or tenosynovitis in PIPJs independently increased more than twice probability of joint tenderness (OR = 2.09 or 2.83, both p < 0.001). Conclusions In consideration of asymmetric MRI features in early RA, potential overuse influence for certain tenosynovitis in dominant hands, and high prevalence of MRI findings in PIPJs, MRI examination on bilateral hands including PIPJs is deserved for disease assessment in early RA patients.
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Affiliation(s)
- Ying-Qian Mo
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ze-Hong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jun-Wei Wang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Qian-Hua Li
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xin-Yun Du
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - T W Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - X M E Matthijssen
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Guang-Zi Shi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lie Dai
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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Park CH, Kim BS, Lee JH, Chung SG. Optimal Elbow Positions for Identification of the Radial Collateral Ligament Using Ultrasonography. PM R 2019; 12:671-678. [PMID: 31671237 DOI: 10.1002/pmrj.12274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/24/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The standard position for examining the lateral elbow with ultrasonography is an "extended" or "slightly flexed" position. However, because the radial collateral ligament (RCL) is more deeply attached on the lateral epicondyle than the common extensor tendon, an anisotropic artifact of the RCL could be observed in the conventional positions, making it difficult to fully visualize the RCL. OBJECTIVES To determine optimal elbow positions for accurate identification of the RCL and to explore the relevant landmarks in ultrasonography. DESIGN Prospective study. SETTING Tertiary university hospital. PARTICIPANTS Forty healthy elbows of 20 participants. METHODS The RCL was evaluated using ultrasonography in six elbow flexion positions (0°, 30°, 60°, 90°, 120°, and 140°). The relative depth, defined as the depth of the capitellum subtracted by the depth of the radial head under ultrasonography, was measured at each angle. The rates of successful identification of ultrasonographic landmarks for localizing the RCL were calculated. After ultrasonography, the optimal elbow position for identifying the RCL was determined by group consensus. MAIN OUTCOME MEASUREMENTS Relative depth between radial head and capitellum, rates of successful identification of ultrasonographic landmarks, and consensus-based determination of the optimal angle. RESULTS The relative depth significantly decreased with an increase in the flexion angle (P for trend <.001), approaching zero at the angles of 90° and 120°. The rates of successful identification of the superior tubercle, hyperechogenic line, and anterior and posterior tubercles were 100%, 100%, 90%, and 80%, respectively. In the group consensus, the 90° and 120° flexion angles were selected with the highest frequency (90%; 36/40). CONCLUSION Our findings suggest that elbow flexion at 90° or 120° is optimal for visualization of the RCL with the least possibility of anisotropy under ultrasonography, suggesting that the elbow should be flexed considerably beyond the conventional extended or slightly flexed position.
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Affiliation(s)
- Chul-Hyun Park
- Department of Rehabilitation Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.,Chung-Ang University College of Medicine and Graduate School of Medicine, Seoul, Republic of Korea
| | - Beom Suk Kim
- Department of Physical Medicine & Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jae Hyun Lee
- Department of Rehabilitation Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.,Institute of Aging, Seoul National University, Seoul, Republic of Korea.,Rheumatism Research Institute, Medical Research Center, Seoul National University, Seoul, Republic of Korea
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Abdel-Magied RA, AbuOmar HA, Ali LH, Talaat H, Mohamed FI. Diagnostic potential of ultrasound in systemic lupus erythematosus patients with joint involvement: Relation to anticyclic citrullinated peptide (anti-CCP), disease activity and functional status. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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10
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Di Matteo A, Isidori M, Corradini D, Cipolletta E, McShane A, De Angelis R, Filippucci E, Grassi W. Ultrasound in the assessment of musculoskeletal involvement in systemic lupus erythematosus: state of the art and perspectives. Lupus 2019; 28:583-590. [PMID: 30841789 DOI: 10.1177/0961203319834671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Musculoskeletal manifestations are extremely common in patients with systemic lupus erythematosus. Transient and migratory arthralgia is frequently reported even without clinical signs of joint or tendon inflammation. In less than 15% of patients, joints may be more severely affected by deforming (Jaccoud's arthropathy) and/or erosive arthropathy (Rhupus syndrome). In recent years, ultrasound has emerged as a promising imaging technique for the assessment of musculoskeletal involvement in systemic lupus erythematosus, having demonstrated the ability to detect inflammation and structural damage both at articular and periarticular level. Recent ultrasound studies have also revealed new insights into musculoskeletal involvement in patients with systemic lupus erythematosus, some of them questioning the traditional concepts of systemic lupus erythematosus arthropathy, with potential clinical, prognostic and therapeutic implications. In daily clinical practice, the use of ultrasound in the assessment of joint and tendon involvement in patients with systemic lupus erythematosus is still limited. Several methodological issues encountered in ultrasound studies evaluating musculoskeletal involvement in systemic lupus erythematosus patients need to be addressed in order to improve both the reliability and clinical usefulness of ultrasound findings. This paper reviews ultrasound studies assessing musculoskeletal involvement in patients with systemic lupus erythematosus, highlighting certainty, limits, potential applications and future perspectives of ultrasound use in systemic lupus erythematosus patients.
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Affiliation(s)
- A Di Matteo
- 1 Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - M Isidori
- 1 Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - D Corradini
- 1 Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - E Cipolletta
- 1 Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - A McShane
- 2 Rheumatology Department, Musgrave Park Hospital, Belfast, UK
| | - R De Angelis
- 1 Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - E Filippucci
- 1 Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
| | - W Grassi
- 1 Department of Clinical and Molecular Sciences, Rheumatology Unit, Polytechnic University of Marche, Ancona, Italy
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Han N, Tian X. Detection of subclinical synovial hypertrophy by musculoskeletal gray-scale/ power Doppler ultrasonography in systemic lupus erythematosus patients: A cross-sectional study. Int J Rheum Dis 2019; 22:1058-1069. [PMID: 30834675 DOI: 10.1111/1756-185x.13525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/12/2019] [Accepted: 02/01/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Laboratory investigations are invasive methods. Magnetic resonance imaging (MRI) has a small field of view. Ultrasound can be performed at multiple parts of the body. The objective of the study was to find out subclinical synovial hypertrophy in systemic lupus erythematosus patients using gray-scale/power Doppler ultrasonography. METHODS A total of 247 systemic lupus erythematosus (without musculoskeletal involvement) patients from 21 February 2017 to 28 October 2018 were included in the cross-sectional study. Patients were subjected to physical examinations, laboratory tests, and gray-scale/power Doppler ultrasonography examinations. Synovial hypertrophy was confirmed if it was present in at least 4 out of 100 of the examined location sites. MRI examinations were performed for confirmation purposes. Spearman correlation was performed between imaging and laboratory investigations at the 99% confidence level. RESULTS No correlation was observed for results of synovial hypertrophy between physical examinations/laboratory tests and gray-scale/power Doppler ultrasonography examinations except erythrocyte sedimentation rate (r = 0.354). Cost of laboratory tests (315.47 ± 19.15 ¥/person) for subclinical synovial hypertrophy detection was higher than that of gray-scale/power Doppler ultrasonography examinations (135.47 ± 8.17 ¥/person, P <0.0001, q = 230.87). Results of gray-scale/power Doppler ultrasonography have a correlation with results of MRI (r = 0.34). CONCLUSION Only perform gray-scale/power Doppler ultrasonography examinations for regular maintenance of rheumatologic disease in systemic lupus erythematosus patients.
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Affiliation(s)
- Nan Han
- Department of Ultrasonography, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiliang Tian
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Zhang YH, Li K, Xiao J, Zhang HD, Zhang XY. Comparison of Ultrasound, Radiography, and Clinical Investigations in the Diagnosis of Early Rheumatoid Synovitis in Patients with Nonspecific Musculoskeletal Symptoms: A Multicenter Cross-Sectional Study. Med Sci Monit 2018; 24:4372-4378. [PMID: 29939979 PMCID: PMC6048998 DOI: 10.12659/msm.908755] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of rheumatoid synovitis can reduce the progression of rheumatoid arthritis (RA). However, in the early stages of rheumatoid synovitis, patients may only have non-specific musculoskeletal symptoms, and plain film radiographs may not detect early synovial changes. The aim of this study was to compare the sensitivity and specificity of ultrasound with radiography, and clinical investigations in the detection of rheumatoid synovitis in patients presenting with nonspecific musculoskeletal symptoms. MATERIAL AND METHODS This was a non-randomized, cross-sectional, clinical study that included 189 patients who had nonspecific musculoskeletal symptoms. All patients underwent clinical investigations, postero-anterior and dorsal radiographic imaging, and bilateral grey-scale ultrasound examinations of the third and second metacarpophalangeal (MCP) joints, the third and the second proximal interphalangeal (PIP) joints, the second and the fifth metatarsophalangeal (MTP) joints, and the wrist. RESULTS There was no clear predictive value for detection of early synovitis by clinical investigations alone. Plain film radiography of patients only provided accurate information of joint erosions but less information for synovitis. Grey-scale ultrasound was more effective at detecting early synovitis compared with clinical investigations (p=0.00015; q=4.548) and compared with plain film radiography (p=0.0002; q=4.537), and quantified the synovial changes. The predictive values of plain film radiography and clinical investigations had 0.43 and 0.24 sensitivity and 0 specificity compared with ultrasound. CONCLUSIONS The findings of this study support the use of grey-scale ultrasound in the detection of early rheumatoid synovitis of the fingers and the wrist.
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Affiliation(s)
- Ying-Hua Zhang
- Department of Ultrasonography, Jining No. 1 Peoples' Hospital, Jining, Shandong, China (mainland)
| | - Kang Li
- Department of Bone and Joint Surgery, Heze Municipal Hospital, Heze, Shandong, China (mainland)
| | - Jing Xiao
- Department of Ultrasonography, Jining No. 1 Peoples' Hospital, Jining, Shandong, China (mainland)
| | - Hai-Dong Zhang
- Department of Functional Studies, Yanzhou Hospital of Traditional Chinese Medicine, Yanzhou, Shandong, China (mainland)
| | - Xiao-Yan Zhang
- Department of Ultrasonography, Rencheng District First Maternal and Child Health Care Hospital, Jining, Shandong, China (mainland)
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Sonographic Findings of Hands and Wrists in Systemic Lupus Erythematosus Patients With Jaccoud Arthropathy. J Clin Rheumatol 2018; 24:70-74. [DOI: 10.1097/rhu.0000000000000622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Salliot C, Denis A, Dernis E, Andre V, Perdriger A, Albert JD, Mammou Mraghni S, Griffoul-Espitalier I, Hamidou M, Le Goff B, Joulin SJ, Marhadour T, Richez C, Poursac N, Lazaro E, Rist S, Corondan A, Quinten C, Martaillé V, Valéry A, Ducourau E. Ultrasonography and detection of subclinical joints and tendons involvements in Systemic Lupus erythematosus (SLE) patients: A cross-sectional multicenter study. Joint Bone Spine 2018; 85:741-745. [PMID: 29454670 DOI: 10.1016/j.jbspin.2018.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/31/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aims of this study in SLE population were (1) to describe ultrasonography (US) joint abnormalities, (2) to estimate the reliability of clinical swollen joint count (C-SJC) and SLEDAI (C-SLEDAI) versus US-SJC and US-SLEDAI scores, (3) to highlight specific patterns of lupus patients with Power Doppler (PD) abnormalities. METHOD For this cross-sectional multicenter study, 151 consecutive adult SLE patients were recruited. Evaluation included a clinical standardized joint assessment, B-mode and PD US of 40 joints and 26 tendons blinded for clinical examination. Reliability and agreement between clinical and B-mode US were calculated using the intraclass correlation coefficients (ICC [95% Confidence Interval]). RESULTS We found a very high frequency of subclinical US abnormalities in asymptomatic patients: 85% of patients without joint symptoms had at least 1 US abnormality. Among them 46 patients (87%) had a history of joint involvement. The most frequent abnormalities were joint effusmaions (108 patients), synovial hypertrophy (SH, 109 patients) and synovitis (61 patients). Joint or tendon PD signal (grade>1) was found in 44% of patients (67/151). Synovitis were mainly located especially on MCPs and wrists. Even if reliability between clinical and grey-scale US SJC assessments was poor, reliability between clinical and US SLEDAI was good. Comparison between SLE patients with and without PD signal did not show any specific SLE pattern. CONCLUSION US may be useful to assess joint involvement in SLE patients but did not significantly change SLEDAI score.
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Affiliation(s)
- Carine Salliot
- Rheumatology Unit, centre hospitalier regional d'Orleans, 14, avenue de l'Hôpital, CS 86709, 45067 Orleans cedex 2, France.
| | - Amélie Denis
- Rheumatology, centre hospitalier du Mans, 72037 Le Mans, France
| | | | - Vincent Andre
- Rheumatology, centre hospitalier du Mans, 72037 Le Mans, France
| | | | | | | | | | | | | | | | | | | | | | | | - Stéphanie Rist
- Rheumatology Unit, centre hospitalier regional d'Orleans, 14, avenue de l'Hôpital, CS 86709, 45067 Orleans cedex 2, France
| | - Anca Corondan
- Rheumatology Unit, centre hospitalier regional d'Orleans, 14, avenue de l'Hôpital, CS 86709, 45067 Orleans cedex 2, France
| | - Clara Quinten
- Rheumatology Unit, centre hospitalier regional d'Orleans, 14, avenue de l'Hôpital, CS 86709, 45067 Orleans cedex 2, France
| | - Virginie Martaillé
- Rheumatology Unit, centre hospitalier regional d'Orleans, 14, avenue de l'Hôpital, CS 86709, 45067 Orleans cedex 2, France
| | - Antoine Valéry
- DIM, Centre hospitalier regional d'Orleans, 45067 Orleans cedex 2, France
| | - Emilie Ducourau
- Rheumatology Unit, centre hospitalier regional d'Orleans, 14, avenue de l'Hôpital, CS 86709, 45067 Orleans cedex 2, France
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Ribeiro DS, Lins CF, Galvão V, Santos WGD, Rosa G, Machicado V, Pedreira AL, da Fonseca EP, Souza APMD, Baleeiro C, Ferreira LG, Oliveira ISD, Gama da Silva JPC, Atta AM, Santiago MB. Association of CXCL13 serum level and ultrasonographic findings of joints in patients with systemic lupus erythematosus and Jaccoud’s arthropathy. Lupus 2018; 27:939-946. [DOI: 10.1177/0961203317753557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- D Sá Ribeiro
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - C F Lins
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - V Galvão
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | - G Rosa
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - V Machicado
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - A L Pedreira
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - E P da Fonseca
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | - C Baleeiro
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - L G Ferreira
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - I Silva de Oliveira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - J P Cotrim Gama da Silva
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - A M Atta
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - M B Santiago
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Serviços Especializados em Reumatologia da Bahia, Salvador, Bahia, Brazil
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Di Matteo A, De Angelis R, Cipolletta E, Filippucci E, Grassi W. Systemic lupus erythematosus arthropathy: the sonographic perspective. Lupus 2017; 27:794-801. [PMID: 29237324 DOI: 10.1177/0961203317747716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Despite being promising, the use of ultrasound (US) in the assessment of musculoskeletal manifestations of systemic lupus erythematosus (SLE) is still limited. Literature on this topic is scarce and the spectrum and clinical relevance of US abnormalities has not yet been outlined. With this paper, we aim to explore the panel of joint and tendon US findings in a group of SLE patients. Methods Twenty-five consecutive SLE patients, with current or medical history of musculoskeletal symptoms, were studied. All patients underwent routine clinical examination and US evaluation. The US examination targeted sites clinically involved in the physical examination and/or indicated as painful in the patient's medical history. Results One or more US changes were found in all the patients. US abnormalities were detected in 85 out of the 243 scanned joints (35%), in 70 out of the 215 scanned tendons (32.6%) and in 10 out of the 41 scanned entheses (24.4%). Synovial effusion, synovial hypertrophy, "mixed" synovitis (coexistence of synovial effusion and synovial hypertrophy), joint dislocation, bone erosion, and cartilage damage were found in 9.5%, 11.5%, 14%, 3.7%, 2.1%, and 4.5% of the scanned joints, respectively. Tenosynovitis, tendon dislocation, tendon tear, tendon thinning, and tendinitis/peritendinitis were detected in 17.7%, 8.4%, 0.9%, 4.2%, and 4.7% of the scanned tendons, respectively. Power Doppler signal, hypoechogenicity, thickening, enthesophytes, calcifications, and bone erosions were detected at the entheseal level in 12.2%, 9.8%, 12.2%, 7.3%, 7.3%, and in 0% of the scanned entheses, respectively. Conclusions This study revealed an unexpectedly wide heterogeneity of US pathologic findings in the joints and tendons of patients with SLE. A broad spectrum of US changes also involving anatomic structures not considered in previous investigations, including entheses and tendons with no synovial sheath, was detected. These preliminary results suggest that US is able to identify several US "patterns" whose clinical, prognostic, and pathogenetic significance is still to be defined.
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Affiliation(s)
- A Di Matteo
- Clinica Reumatologica, "C. Urbani" Hospital, 9294 Università Politecnica delle Marche , Jesi, Italy
| | - R De Angelis
- Clinica Reumatologica, "C. Urbani" Hospital, 9294 Università Politecnica delle Marche , Jesi, Italy
| | - E Cipolletta
- Clinica Reumatologica, "C. Urbani" Hospital, 9294 Università Politecnica delle Marche , Jesi, Italy
| | - E Filippucci
- Clinica Reumatologica, "C. Urbani" Hospital, 9294 Università Politecnica delle Marche , Jesi, Italy
| | - W Grassi
- Clinica Reumatologica, "C. Urbani" Hospital, 9294 Università Politecnica delle Marche , Jesi, Italy
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17
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Lins CF, Lima de Sá Ribeiro D, Dourado Santos WG, Rosa G, Machicado V, Pedreira AL, Pimenta da Fonseca E, Mota Duque Sousa AP, Rodrigues Silva CB, Matos MAA, Santiago MB. Ultrasound Findings on Hands and Wrists of Patients with Systemic Lupus Erythematosus: Relationship with Physical Examination. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1764-1768. [PMID: 28602490 DOI: 10.1016/j.ultrasmedbio.2017.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
Diagnosis of synovitis/tenosynovitis by physical examination can be difficult. Ultrasound (US) can be an effective tool for the evaluation of joint involvement in systemic lupus erythematosus (SLE). This study will describe musculoskeletal findings by US in SLE patients and the evaluation of their correlation with physical examination. SLE patients underwent clinical/sonographic evaluation of hand/wrists. In total, 896 joints were evaluated: at least 1 change on physical examination was found in 136 joints and at least 1 US abnormality was found in 65 of 896 joints. Out of the 65 joints with US changes, only 13 had findings on physical examination. Conversely, 111 joints had tenderness on physical examination with no sonographic abnormalities. Tenosynovitis was statistically significant more frequently with joint edema (41%) (p = 0.0003). US can detect musculoskeletal changes in only a minority of symptomatic SLE patients. Clinical findings may be related to some reasons that cannot be explained using US.
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Affiliation(s)
| | | | | | - Genevievi Rosa
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | | | | | | | | | | | - Mittermayer Barreto Santiago
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Serviços Especializados em Reumatologia da Bahia, Salvador, Bahia, Brazil
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18
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Ceccarelli F, Perricone C, Cipriano E, Massaro L, Natalucci F, Capalbo G, Leccese I, Bogdanos D, Spinelli FR, Alessandri C, Valesini G, Conti F. Joint involvement in systemic lupus erythematosus: From pathogenesis to clinical assessment. Semin Arthritis Rheum 2017; 47:53-64. [DOI: 10.1016/j.semarthrit.2017.03.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/22/2017] [Accepted: 03/31/2017] [Indexed: 12/13/2022]
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Masci F, Tassoni M, Bossi M, Magenta Biasina A, Serrao G, Rosecrance J, Colosio C. Assessing the effects of biomechanical overload on dairy parlor workers' wrist: Definition of a study approach and preliminary results. Work 2017; 55:747-756. [PMID: 28059827 DOI: 10.3233/wor-162462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dairy milking is a demanding work task that has been associated with hand and wrist musculoskeletal disorders. Clinical approaches to identify the early effects of musculoskeletal disorders among dairy parlor workers' wrist have not been well defined. OBJECTIVES The purpose of this pilot study was to develop a study protocol that would assist in the identification and quantification of hand and wrist disorders among dairy workers that perform tasks in the dairy parlor. Additionally, such a study protocol was needed to perform relatively rapid assessments of the wrist/hand on large samples of dairy workers. METHODS Fourteen dairy parlor workers were assessed for i) upper limb symptoms and work history through questionnaire, ii) a physical examination of the upper limb and in particular wrists and iii) wrist ultrasonography. An additional 21 unexposed paired participants (the control group) also participated in the data collection. RESULTS The study results identified two ultrasound acoustic windows characterized by the highest predictive value for alteration of the wrist's structure. Study results indicated an impairment of the distal median nerve in structure and mobility and impairment of the distal tendon of the muscle extensor carpi ulnaris that included dislocation and frank damage. CONCLUSIONS This study identified at least two acoustic windows that should be assessed with ultrasound studies on larger groups and in prospective periodical health surveillance of dairy workers. The study confirmed the wrist was at risk for biomechanical stress among workers conducting milking tasks in the dairy parlors.
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Affiliation(s)
- F Masci
- Department of Health Sciences of the University of Milan and International Center for Rural Health of San Paolo Hospital, Milan, Italy
| | - M Tassoni
- San Paolo Ultrasounds Medical School, S. Paolo Hospital, University of Milan, Milan, Italy
| | - M Bossi
- Department of Health Sciences of the University of Milan and International Center for Rural Health of San Paolo Hospital, Milan, Italy
| | - A Magenta Biasina
- San Paolo Ultrasounds Medical School, S. Paolo Hospital, University of Milan, Milan, Italy
| | - G Serrao
- San Paolo Ultrasounds Medical School, S. Paolo Hospital, University of Milan, Milan, Italy
| | - J Rosecrance
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - C Colosio
- Department of Health Sciences of the University of Milan and International Center for Rural Health of San Paolo Hospital, Milan, Italy
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Ruano CA, Malheiro R, Oliveira JF, Pinheiro S, Vieira LS, Moraes-Fontes MF. Ultrasound detects subclinical joint inflammation in the hands and wrists of patients with systemic lupus erythematosus without musculoskeletal symptoms. Lupus Sci Med 2017; 4:e000184. [PMID: 28123769 PMCID: PMC5255563 DOI: 10.1136/lupus-2016-000184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/12/2016] [Accepted: 11/05/2016] [Indexed: 12/30/2022]
Abstract
Objectives To assess the prevalence and severity of ultrasonographic abnormalities of the hand and wrist of asymptomatic patients with systemic lupus erythematosus (SLE) and compare these findings with those from patients with SLE with musculoskeletal signs or symptoms and healthy controls. Methods We conducted a prospective cross-sectional study that evaluated bilaterally, with grey-scale and power Doppler (PD) ultrasound (US), the dorsal hand (2nd to 5th metacarpophalangeal and 2nd to 5th proximal interphalangeal joints) and wrist (radiocarpal, ulnocarpal and intercarpal joints) of 30 asymptomatic patients with SLE, 6 symptomatic patients with SLE and 10 controls. Synovial hypertrophy (SH) and intra-articular PD signal were scored using semiquantitative grading scales (0–3). Individual scores were graded as normal (SH≤1 and PD=0) or abnormal (SH≥2 or PD≥1). Global indexes for SH and PD were also calculated. US findings were correlated with clinical and laboratory data and disease activity indexes. Results US detected SH (score ≥1) in 77% asymptomatic patients with SLE, mostly graded as minimal (score 1: 63%). 23% of the asymptomatic patients with SLE showed abnormal US PD findings (SH≥2 or PD≥1). SH was present in all symptomatic patients with SLE, mostly graded as moderate (grade 2: 67%), and with associated PD signal (83%). SH (score 1) was identified in 50% of controls, however, none presented abnormal US PD findings. SH index in the asymptomatic SLE group was higher than in the control group (2.0 (0–5) vs 0.5 (0–2), median (range), p=0.01) and lower than in the symptomatic SLE group (7.0 (4–23), median (range), p<0.001). No significant correlation was demonstrated between US PD findings and clinical or laboratory variables and disease activity indexes. Conclusion A small subgroup of asymptomatic patients with SLE may present subclinical joint inflammation. Global US scores and PD signal may be important in disease evaluation and therapeutic monitoring.
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Affiliation(s)
- Carina A Ruano
- Radiology Department , Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central (CHLC) , Lisbon , Portugal
| | - Rui Malheiro
- Autoimmune Disease Unit,Unidade de Doenças Auto-imunes/Serviço Medicina 3, Hospital de Santo António dos Capuchos, CHLC, Lisbon, Portugal; Núcleo de Estudos de Doenças Auto-imunes da Sociedade Portuguesa de Medicina Interna (NEDAI/SPMI), Lisbon, Portugal
| | - João F Oliveira
- Autoimmune Disease Unit,Unidade de Doenças Auto-imunes/Serviço Medicina 3, Hospital de Santo António dos Capuchos, CHLC, Lisbon, Portugal; Núcleo de Estudos de Doenças Auto-imunes da Sociedade Portuguesa de Medicina Interna (NEDAI/SPMI), Lisbon, Portugal
| | - Sofia Pinheiro
- Autoimmune Disease Unit,Unidade de Doenças Auto-imunes/Serviço Medicina 3, Hospital de Santo António dos Capuchos, CHLC, Lisbon, Portugal; Núcleo de Estudos de Doenças Auto-imunes da Sociedade Portuguesa de Medicina Interna (NEDAI/SPMI), Lisbon, Portugal
| | - Luís S Vieira
- Radiology Department , Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central (CHLC) , Lisbon , Portugal
| | - Maria Francisca Moraes-Fontes
- Núcleo de Estudos de Doenças Auto-imunes da Sociedade Portuguesa de Medicina Interna (NEDAI/SPMI), Lisbon, Portugal; Autoimmune Disease Unit, Unidade de Doenças Auto-imunes/Serviço Medicina 7.2, Hospital Curry Cabral, CHLC, Lisbon, Portugal
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Corzo P, Salman-Monte TC, Torrente-Segarra V, Polino L, Mojal S, Carbonell-Abelló J. Joint ultrasound baseline abnormalities predict a specific long-term clinical outcome in systemic lupus erythematosus patients. Lupus 2016; 26:729-733. [DOI: 10.1177/0961203316676376] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective To describe long-term clinical and serological outcome in all systemic lupus erythematosus (SLE) domains in SLE patients with hand arthralgia (HA) and joint ultrasound (JUS) inflammatory abnormalities, and to compare them with asymptomatic SLE patients with normal JUS. Methods SLE patients with HA who presented JUS inflammatory abnormalities (‘cases’) and SLE patients without HA who did not exhibit JUS abnormalities at baseline (‘controls’) were included. All SLE clinical and serological domain involvement data were collected. End follow-up clinical activity and damage scores (systemic lupus erythematosus disease activity index (SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR)) were recorded. JUS inflammatory abnormalities were defined based on the Proceedings of the Seventh International Consensus Conference on Outcome Measures in Rheumatology Clinical Trials (OMERACT-7) definitions. Statistical analyses were carried out to compare ‘cases’ and ‘controls’. Results A total of 35 patients were recruited. The ‘cases’, n = 18/35, had a higher incidence of musculoskeletal involvement (arthralgia and/or arthritis) through the follow-up period (38.9% vs 0%, p = 0.008) and received more hydroxychloroquine (61.1% vs 25.0%, p = 0.034) and methotrexate (27.8% vs 0%, p = 0.046) compared to ‘controls’, n = 17/35. Other comparisons did not reveal any statistical differences. Conclusions We found SLE patients with arthralgia who presented JUS inflammatory abnormalities received more hydroxychloroquine and methotrexate, mainly due to persistent musculoskeletal involvement over time. JUS appears to be a useful technique for predicting worse musculoskeletal outcome in SLE patients.
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Affiliation(s)
- P Corzo
- Department of Rheumatology, Hospital del Mar/Parc de Salut Mar. Department of Medicine, Universitat Auta de Barcelona, Barcelona, Spain
| | - T C Salman-Monte
- Department of Rheumatology, Hospital del Mar/Parc de Salut Mar. Department of Medicine, Universitat Auta de Barcelona, Barcelona, Spain
| | - V Torrente-Segarra
- Department of Rheumatology, Hospital del Mar/Parc de Salut Mar. Department of Medicine, Universitat Auta de Barcelona, Barcelona, Spain
- Rheumatology Department, Hospital General Hospitalet-Moisès Broggi, Hospitalet Llobregat, Spain
| | - L Polino
- Department of Rheumatology, Hospital del Mar/Parc de Salut Mar. Department of Medicine, Universitat Auta de Barcelona, Barcelona, Spain
| | - S Mojal
- Unitat de Assessorament Metodològic a la Investigació Biomèdica, Barcelona, Spain
| | - J Carbonell-Abelló
- Department of Rheumatology, Hospital del Mar/Parc de Salut Mar. Department of Medicine, Universitat Auta de Barcelona, Barcelona, Spain
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Piga M, Gabba A, Congia M, Figus F, Cauli A, Mathieu A. Predictors of musculoskeletal flares and Jaccoud׳s arthropathy in patients with systemic lupus erythematosus: A 5-year prospective study. Semin Arthritis Rheum 2016; 46:217-224. [DOI: 10.1016/j.semarthrit.2016.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/14/2016] [Accepted: 04/25/2016] [Indexed: 01/15/2023]
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Di Matteo A, Satulu I, Di Carlo M, Lato V, Filippucci E, Grassi W. Entheseal involvement in systemic lupus erythematosus: are we missing something? Lupus 2016; 26:320-328. [PMID: 27496900 DOI: 10.1177/0961203316662723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Musculoskeletal involvement is extremely common in patients with systemic lupus erythematosus (SLE). Continuing the research initiated in patients with inflammatory arthritis, recent studies have shown the potential role of musculoskeletal ultrasound (MSUS) in the evaluation of clinical and subclinical lupus synovitis. The inflammatory process in SLE is traditionally considered to be localized at synovial tissue areas while enthesis is not included among the possible targets of the disease. Patients and methods Entheses included in the Glasgow Ultrasound Enthesitis Scoring System were scanned in a cohort of 20 SLE patients serving as disease controls in an MSUS study aimed at assessing enthesitis in patients with psoriatic arthritis. We describe in detail four cases with unexpected and unequivocal expressions of MSUS enthesitis according to the OMERACT definition. Three out of four patients had no predisposing factors for enthesopathy. Case no. 2 was treated with a variable-dose prednisone regimen. Results In the four cases MSUS examination revealed relevant grey-scale and power Doppler abnormalities at the entheseal level, most commonly at the distal insertion of the patellar tendon. Signs of clinical enthesitis were detected in only one patient. Conclusions This case series shows for the first time the presence of clearly evident MSUS findings indicative of enthesitis in four out of 20 SLE patients (20%), raising the hypothesis that enthesis could be a missing target in the clinical evaluation of SLE patients. Our case series justifies further investigations for a better evaluation of the prevalence, characteristics and clinical relevance of entheseal involvement in SLE.
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Affiliation(s)
- A Di Matteo
- 1 Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - I Satulu
- 2 Internal Medicine and Rheumatology Department, "Dr. I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - M Di Carlo
- 1 Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - V Lato
- 1 Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - E Filippucci
- 1 Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - W Grassi
- 1 Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
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Feced Olmos CM, Ivorra Cortés J, Negueroles Albuixech R, Román Ivorra JA. Usefulness of ultrasound in Jaccoud's arthropathy. A case report. REUMATOLOGIA CLINICA 2015; 11:127-129. [PMID: 25443561 DOI: 10.1016/j.reuma.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/09/2014] [Accepted: 08/22/2014] [Indexed: 06/04/2023]
Affiliation(s)
| | - José Ivorra Cortés
- Servicio de Reumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
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Lins CF, Santiago MB. Ultrasound evaluation of joints in systemic lupus erythematosus: a systematic review. Eur Radiol 2015; 25:2688-92. [PMID: 25716942 DOI: 10.1007/s00330-015-3670-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/30/2015] [Accepted: 02/13/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of this systematic review is to describe the scientific evidence regarding sonographic findings of joints in SLE patients. METHODS Seven databases were searched (PubMed, ScienceDirect, Scopus, Cochrane, EMBASE, LILACS, and SciELO) for articles from 1950 to January 2015. The keywords used for selecting articles include "lupus", "ultrasound imaging", "ultrasonography", "synovitis", "tenosynovitis", and "arthritis". RESULTS A total of 12 articles were included in the final analysis. In total, 610 SLE patients and 1,091 joints were studied. Most patients underwent bilateral joint examination by US. A total of 888 hands and wrists, 154 ankles/feet, and 56 knees were examined. Effusion was identified in 602 joints, synovitis in 213, tenosynovitis in 210, synovial hypertrophy in 150, and bone erosions in 73 cases. The majority of the studies demonstrated higher frequency of musculoskeletal abnormalities on US than those observed on physical examination. CONCLUSION US seems to be a valuable tool to identify subclinical joint manifestations in SLE. Prospective studies are necessary to determine if those patients with subclinical joint abnormalities have a higher risk for the development of chronic deformities as those seen in Jaccoud's Arthropathy. KEY POINTS • Musculoskeletal involvement occurs in more than 90% of SLE cases. • Arthralgia or tender/swollen joints found on physical examination showed more US findings. • Patients without joint symptoms or physical examinations changes showed musculoskeletal sonographic findings. • US became a useful tool for rheumatologists. • A substantial number of asymptomatic patients show abnormalities at musculoskeletal US.
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Affiliation(s)
- Carolina F Lins
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, 40290-000, Salvador, Bahia, Brazil
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26
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Dreyer L, Jacobsen S, Juul L, Terslev L. Ultrasonographic abnormalities and inter-reader reliability in Danish patients with systemic lupus erythematosus - a comparison with clinical examination of wrist and metacarpophalangeal joints. Lupus 2014; 24:712-9. [PMID: 25467390 DOI: 10.1177/0961203314561666] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 11/05/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVES We aimed to determine 1) ultrasound (US) abnormalities in patients with systemic lupus erythematosus (SLE) with and without hand arthralgia at the day of examination compared with clinical evaluation and healthy controls, and 2) inter-observer reliability of the US abnormalities. METHODS Thirty-three female SLE patients were twice examined with US by three trained examiners. Using B-mode and Doppler US, unilateral wrist and metacarpophalangeal (MCP) joints were examined for synovitis and erosions as well as signs of hand tenosynovitis using a GE Logiq 9 US machine with Doppler settings for slow flow. All patients also underwent clinical joint evaluation and were compared with 11 healthy controls (HC). RESULTS Among the patients with SLE 16 (48%) had signs of wrist synovitis, which was only observed in one HC (p = 0.03). Corresponding figures for any MCP joint were 12 (36%) and 0 (p = 0.06). In SLE patients, 18% had hand tenosynovitis and 6% bone erosions. Wrist synovitis was detected by US in 16 SLE patients (81%) with arthralgia compared with 17 patients without (18%) (p = 0.0005). Any US abnormalities were observed in 44% of 25 wrists without tenderness at clinical examination and in 46% of 26 wrists without swelling. Corresponding percentages for MCP2 joints were 27% and 21%. Inter-observer reliability of the US findings was good to excellent for examination of hand joints and tendons. CONCLUSIONS A majority of SLE patients with hand arthralgia showed US signs of synovitis, erosions and tenosynovitis indicating subclinical disease. Even SLE patients without clinical signs of joint inflammation demonstrated US abnormalities. Good to excellent inter-observer reliability was found in US evaluation of hands in patients with SLE.
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Affiliation(s)
- L Dreyer
- Department of Rheumatology, Copenhagen University Hospital, Gentofte, Denmark Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - S Jacobsen
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Juul
- Department of Rheumatology, Copenhagen University Hospital, Gentofte, Denmark
| | - L Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark
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