title: Benefits of ultrasonography in the management of early arthritis: a cross-sectional study of baseline data from the ESPOIR cohort.
abstract: OBJECTIVE
  To assess ultrasonography's (US) performance to detect the structural damage in the initial evaluation of early arthritis (EA) using the Etude et Suivides Polyarthrites Indifférenciées Récentes (ESPOIR) cohort.
  
  
  METHODS
  ESPOIR is a French, multi-centric EA cohort. Four centres assessed the structural damage by both X-ray and US examination at baseline. X-rays of hands and feet were read first by the centre's local investigator (usual reading), then in the X-ray coordinating centre (central reading). Four trained examiners performed US blindly from clinical data to detect erosions on the second and fifth MCP (MCP2 and 5) and the fifth MTP (MTP5) joints bilaterally.
  
  
  RESULTS
  Patients' characteristics (n = 126) were: female 78%; mean age 50.3 years; disease duration 103 days; disease activity score on 28 joints 5; CRP level 22.7 mg/l; and 79.4% of the patients fulfilling RA ACR criteria. Twelve patients had missing data for X-rays. US revealed 42 (36.8%) patients with erosive disease, whereas radiography revealed only 30 (26%) with central reading and only 11% with usual reading. US missed erosive disease present in X-rays in 10 (8.8%) patients. Combined technique of both revealed 52 (45.6%) patients with erosive diseases. On the targeted joints, US detected erosion on 75 (11%) joints vs X-rays on only 11 (1.5%). Only three joints with erosion(s) detected on X-rays were missed on US. At baseline, the presence of PD activity was not associated with joint erosions.
  
  
  CONCLUSIONS
  US on six joints detected 1.4-fold more patients with erosions (3.3-fold more with the usual reading). In clinical practice, US combined with X-rays is of helpful diagnostic value in EA.
authors.affiliation: Department of Rheumatology, Academic Hospital Pitie Salpétrière, Paris, France. tfb@free.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Funck-Brentano
authors.forename: Fabien
authors.initials: F
authors.lastname: Etchepare
authors.forename: Sandrine J
authors.initials: SJ
authors.lastname: Joulin
authors.forename: Frédérique
authors.initials: F
authors.lastname: Gandjbakch
authors.forename: Valérie D
authors.initials: VD
authors.lastname: Pensec
authors.forename: Catherine
authors.initials: C
authors.lastname: Cyteval
authors.forename: Anne
authors.initials: A
authors.lastname: Miquel
authors.forename: Mathilde
authors.initials: M
authors.lastname: Benhamou
authors.forename: Frédéric
authors.initials: F
authors.lastname: Banal
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loet
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourgeois
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
mesh_terms: D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging; D008875:Middle Aged; D015588:Observer Variation; D011859:Radiography; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging; D014463:Ultrasonography