High resolution ultrasonography in assessment of rheumatoid knee synovitis : correlation with clinical and laboratory parameters

الملخص EN

The formation of synovial pannus is an early event in the course of rheumatoid arthritis (RA) and could be seen before destruction of the cartilage and bone.

Thus, its evaluation is of great benefit in the treatment and follow-up of clinical remission.

Objective: The aim of this study was to investigate the presence of synovial pannus in the knee of RA patients with high-resolution ultrasonography and correlate the finding with the clinical and laboratory parameters of the disease.

Methodology: Thirty patients suffering from RA diagnosed according to the American College of Rheumatology (ACR) criteria together with 10 apparently healthy volunteers were included in the study.

Both patients and controls were subjected to proper history taking and clinical examination including disease activity scoring (Mallya and Mace 1981) and functional assessment (Steinbrocker criteria, 1949) together with high resolution ultrasonography of the knee.

Soluble adhesion molecules (SICAM-1 and E selectin) in the serum as well as serum and synovial LIF were also done.

Results: A high statistical significant difference was found in all laboratory and clinical findings between the patients group and control group including SICAM-1, SE-selectin, serum and synovial LIF.

Serum and synovial LIF correlated significantly with activity scoring (r= 0.8) and functional status (r= 0.7).

However, SICAM-1 and SE-selectin correlated with activity scoring only (r= 0.48, r= 0.49 respectively).

Ultrasonographic findings were detected in the majority of the patients with statistically significant difference if compared with the control group.

Synovial thickening correlated significantly with disease duration (r= 0.49), functional status (r= 0.58) and synovial LIF (r= 0.59).

Effusion showed a significant correlation with activity scoring (r= 0.5), SICAM-1 (r= 0.42) and synovial LIF (r= 0.59) while cartilage destruction correlated with disease duration (r= 0.51) and serum and synovial LIF (r= 0.53 and 0.65 respectively).

Conclusion: Soluble adhesion molecules may be an additional marker for disease activity while LIF may be an indicator of the severity of the disease.

HRUS can evaluate the pannus formation in a trial to assess disease activity and the degree of severity to aid in therapeutic intervention and follow-up for clinical remission.