Clinical, laboratory and color doppler ultrasonography study of synovitis in rheumatoid arthritis

Abstract EN

Objective : to evaluate the use of color Doppler ultrasonography (US) analysis of the synovial membrane vascularization and its relation to clinical and laboratory manifestations of rheumatoid arthritis patients before and after intra-articular treatment with glucocorticoids in target joints.

Methodology : this study was carried on 30 RA patients who were suffering from one or two joints flare up, thus intra-articular glucocorticoids injection may help to control their condition.

The included joints were 18 wrists and 12 knee joints.

Clinically, the patients were assessment by calculating the mean 0f the articular index score for the patients, by measurement the mean of morning stiffness for them, then disease activity in target joint was estimated clinically by target joint pain on 100mm visual analogue scale (VAS), swelling and tenderness in target joint (which were scored 0-3).

Laboratory investigations especially erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) which were performed for all patients.

Ultrasonography examination: the target joint was scanned by grey mode US and synovial thickness was graded (from 0 to 3), and it was scanned by color Doppler US and resistive index (RI) was calculated as ( peak systolic flow- end diastolic flow) / peak systolic flow, thus sonographer guided intra-articular injection of methylprednisolone was done.

Clinical, laboratory and sonographer examinations were carried out before and also 4 weeks after injection.

Results : There were highly significant difference in morning stiffness (MS), VAS, swelling tenderness, synovial thickness and RI before and 4 weeks after injection (p < 0.001).

As regards to activity in target joint, there was a significant negative correlation between RI and swelling & tenderness (p < 0.05), and a highly significant negative correlation between it and VAS (p < 0.001) before and after injection.

But synovial thickness showed only a significant correlation between it and swelling & ESR 4 weeks after injection (p < 0.05).

Other clinical, laboratory and activity parameters in target joint showed non-significant correlation between them and RI or synovial thickness.

Conclusion : color Doppler US were found to be helpful in detection of response to local treatment with intra-articular corticosteroids and aid in making therapeutic decision.

Also, the RI and synovial thickness are able to detect a treatment with corticosteroids; changes in RI are parallel to changes in clinical evaluation of RA disease.

Thus, imaging assessment may be necessary for the accurate evaluation of disease status and in particular, for the definition of true remission.