title: Value of ultrasonography for diagnosis of synovitis associated with rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the value of ultrasonography (US) for diagnosing synovitis associated with rheumatoid arthritis (RA).
  
  
  METHODS
  Bilateral metacarpophalangeal (MCP), proximal interphalangeal (PIP) II-V and wrist joints of 46 RA patients and 35 healthy controls were evaluated by quantitative and semiquantitative US. Wrists on more severely affected sides of 20 of the 46 patients also underwent magnetic resonance imaging (MRI). The MRI and US results were compared. The US cutoff to distinguish pathology was calculated. The two US methods were compared and the correlation between quantitative methods and clinical serologic markers was analyzed.
  
  
  RESULTS
  The imaging techniques (US and MRI) for detecting synovitis produced consistent results (γ = 0.70-0.77, P < 0.001). When the cutoffs for the MCP and PIP joints were 2.5 and 2.6 mm, respectively; the sensitivities/specificities were 82.8%/85.8% and 98.2%/84.8%, respectively. When the cutoff for the wrist was 5.2 mm, the sensitivity/specificity was 93.4%/93.4%. The average synovial membrane thickness was positively related to biochemical markers erythrocyte sedimentation rate, C-reactive protein, anticyclic citrullinated peptide antibody, and Disease Activity Index of 28 joints (γ = 0.307-0.614; P = 0.020, 0.038, 0.01, < 0.001, respectively) but was poorly related to rheumatoid factor immunoglobulin A (RF-IgA), RF-IgM, and RF-IgG (γ = 0.06-0.115; P = 0.45, 0.45, 0.62, respectively).
  
  
  CONCLUSIONS
  US is a valid method for diagnosing early-stage synovitis, with high-accuracy cutoffs for MCP, PIP and wrist joints set at 2.5, 2.6 and 5.2 mm. The mean synovial thicknesses of the bilateral wrist, MCP II-IV and PIP II-IV joints can be used to assess disease activity.
authors.affiliation: Department of Rheumatology, The Chenzhou First People's Hospital, Changsha, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Xiao
authors.forename: Minghui
authors.initials: M
authors.lastname: Liu
authors.forename: Lihua
authors.initials: L
authors.lastname: Tan
authors.forename: Xiangping
authors.initials: X
authors.lastname: Liao
authors.forename: Yajun
authors.initials: Y
authors.lastname: Li
authors.forename: Jiesheng
authors.initials: J
authors.lastname: Gao
authors.forename: Fen
authors.initials: F
authors.lastname: Li
authors.forename: Xi
authors.initials: X
authors.lastname: Xie
authors.forename: Qinghai
authors.initials: Q
authors.lastname: Peng
authors.forename: Ni
authors.initials: N
authors.lastname: Mao
authors.forename: Jing
authors.initials: J
authors.lastname: Tian
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Du
authors.forename: Jinwei
authors.initials: J
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012217:Rheumatoid Factor / Q000097:blood; D012698:Serologic Tests; D012720:Severity of Illness Index; D013585:Synovitis / Q000097:blood / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor
keywords: magnetic resonance imaging; rheumatoid arthritis; synovitis; ultrasonography