Wrist joint involvement in systemic lupus erythematosus. An ultrasonographic study.
OBJECTIVE
To define joint alterations in the wrists of patients with systemic lupus erythematosus (SLE) by ultrasonography (US).


METHODS
Fifty-two wrists of 26 SLE patients and 30 wrists of 15 healthy controls were evaluated using US by two different experienced operators, blinded to the clinical data. A 14 MHz linear probe was used. Power Doppler (PD) was applied to evaluate the presence of synovial neoangiogenesis as a parameter of active local synovitis. The findings were correlated to the clinical evaluation, serological systemic disease activity parameters (ESR, C3 levels) and the SLE-disease activity score (SLEDAI). Statistical analysis was performed by the EPISTAT program.


RESULTS
Signs of synovitis were found in 22 wrists (42.3%). Synovial proliferation was present in 10 joints (19.2%), PD positivity in 5 (9.6%) and joint effusion in 13 (25%). Erosions were present in both wrists (3.8%) of one patient. Signs of tenosynovitis of one or more tendons were shown in 23 cases (44.2%). Ganglia were found in 2 joints (3.8%). Changes of the median nerve, joint dislocations, tendons' ruptures, cysts and nodules were never detected. In 14 wrists (26.9%) no alterations were found. There was no correlation between sonographic findings and clinical, laboratory and indexes signs of disease activity. In the control group the only alteration found was tenosynovitis in 1 joint (p < 0.0001).


CONCLUSIONS
US proved to be an useful technique to detect wrist joint alterations in SLE. These findings may help the physician to modulate treatment strategies and to perform a low cost monitoring of joint disease activity.
Iagnocco
A
A
Rheumatology Unit, Department of Applied Clinical and Medical Therapy, University of Rome La Sapienza, Italy. annamaria.iagnocco@uniroma1.it
Ossandon
A
A
Coari
G
G
Conti
F
F
Priori
R
R
Alessandri
C
C
Valesini
G
G
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D013717:Tenosynovitis / Q000000981:diagnostic imaging* / Q000209:etiology; D018608:Ultrasonography, Doppler / Q000379:methods; D014955:Wrist Joint / Q000098:blood supply / Q000000981:diagnostic imaging*