title: Is painless synovitis different from painful synovitis? A controlled, ultrasound, radiographic, clinical trial.
abstract: OBJECTIVE
  This study compares the clinical, ultrasonography, radiography, and laboratory outcomes of painless and painful chronic synovitis in patients with established rheumatoid arthritis.
  
  
  METHODS
  This cross-sectional study involved 60 patients with rheumatoid arthritis and synovitis in the metacarpophalangeal joints; 30 of the patients did not experience pain, and 30 had experienced pain for at least 6 months prior to the study. The radiocarpal, distal radioulnar, and metacarpophalangeal joints were evaluated using the ultrasound gray scale, power Doppler, and radiography. Past and present clinical and laboratory findings were also evaluated.
  
  
  RESULTS
  There were no statistically significant differences between the groups for most of the outcomes. The group with pain scored worse on the disease activity indices (e.g., DAS 28 and SDAI), function questionnaires (HAQ and Cochin), and pinch strength test. A logistic regression analysis revealed that the use of an immunobiological agent was associated with a 3-fold greater chance of belonging to the group that experienced pain. The painless group had worse erosion scores in the second and fifth metacarpophalangeal with odd ratios (ORs) of 6.5 and 3.5, respectively. The painless group had more cartilage with grade 4 damage in the third metacarpophalangeal.
  
  
  CONCLUSIONS
  The rheumatoid arthritis patients with both painless and painful synovitis exhibited similar disease histories and radiographic and ultrasound findings. However, the ultrasonography evaluation revealed worse scores in the second and fifth metacarpophalangeal of the synovitis patients who did not experience pain.
authors: Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São Paulo/SP, Brazil.
authors: Daniele Freitas
authors: DF
authors: Pereira
authors: Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São Paulo/SP, Brazil.
authors: Jamil
authors: J
authors: Natour
authors: Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São Paulo/SP, Brazil.
authors: Ana Leticia Pirozzi de
authors: AL
authors: Buosi
authors: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Diagnóstico por Imagem, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Diagnóstico por Imagem, São Paulo/SP, Brazil.
authors: Fernando Bernardes Maia Diniz
authors: FB
authors: Ferreira
authors: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Diagnóstico por Imagem, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Diagnóstico por Imagem, São Paulo/SP, Brazil.
authors: Artur da Rocha Corrêa
authors: Ada R
authors: Fernandes
authors: Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São Paulo/SP, Brazil.
authors: Rita Nely Vilar
authors: RN
authors: Furtado
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011859:Radiography; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013585:Synovitis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018608:Ultrasonography, Doppler