Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus.
OBJECTIVE
To assess the prevalence and severity of inflammatory abnormalities of the hand, wrist and foot joints in SLE patients by US and to correlate them with clinical, laboratory and disease activity score parameters.


METHODS
Sixty-two consecutive SLE patients were enrolled in the present study and underwent clinical evaluation, laboratory tests and bilateral high-resolution US of the hand, wrist and foot joints. Joint effusion (JE), synovial hypertrophy (SH) and local pathological vascularization [power Doppler (PD)] were evaluated according to both a dichotomous score and a semi-quantitative (0-3) grading system. In addition, a global US score was calculated by summing the values given to each elementary lesion for every single joint and every joint group. US findings were correlated with physical examination, serological parameters (CRP, ANA, anti-dsDNA, ENA, aPL, C3 and C4 serum levels) and disease activity indexes (SLEDAI-2K, ECLAM).


RESULTS
US detected inflammatory joint abnormalities in 54/62 patients (87.1%); 72.6% presented involvement of the MTP joints, 46.7% the MCP joints, 19.3% the PIP joints and 53% the wrists. A total of 1984 joints were examined highlighting JE in 19.1% of cases, SH in 6.9% and positive PD in 1.1%. The global US inflammatory score had a mean value of 10.9 (s.d. 15.2). No correlations were found between US findings and SLE disease activity parameters.


CONCLUSIONS
US demonstrated a high prevalence of inflammatory joint abnormalities in SLE that were also present in asymptomatic patients. Interestingly, the foot joints were the most frequently involved. US is a valuable tool for detecting subclinical synovitis in SLE.
Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Viale del Policlinico 155, Rome 00161, Italy. annamaria.iagnocco@uniroma1.it.
Annamaria
A
Iagnocco
Fulvia
F
Ceccarelli
Chiara
C
Rizzo
Simona
S
Truglia
Laura
L
Massaro
Francesca R
FR
Spinelli
Caterina
C
Vavala
Guido
G
Valesini
Fabrizio
F
Conti
D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging*; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000000981:diagnostic imaging*
D002097:C-Reactive Protein
SLE; synovitis; ultrasound