title: The role of imaging in the evaluation of joint involvement in 102 consecutive patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  To assess the prevalence of joint involvement in consecutive patients with systemic lupus erythematosus (SLE) by means of clinical assessment, joint US and MRI and to evaluate the sensitivity and specificity of physician evaluation of joint involvement.
  
  
  METHODS
  At enrollment, patients underwent a complete physical examination including a 44-joint count, and hand deformities were scored. On the day of enrollment, each patient underwent a non-dominant hand-wrist ultrasound (US) examination and a non-dominant hand-wrist MRI study without contrast injection.
  
  
  RESULTS
  One hundred and two patients (F 95, M 7) were enrolled. By physician examination hand or wrist involvement was diagnosed in 23.5%. At least one pathological finding was revealed by US examination at wrist and/or hand joints in 55%. We found a low sensitivity (46.5%) with high specificity (93.2%) of the physician assessment for the evaluation of joint involvement. The MRI imaging showed at least one erosion in 47.3% patients at the hand and in 98.9% at the wrist; in healthy subjects erosions were found in 19.6% and 97.8% at the hand and wrist, respectively.
  
  
  CONCLUSIONS
  In conclusion, (i) physicians tend to underestimate the severity of joint involvement in SLE; (ii) US assessment shows a high prevalence of joint and tendon involvement; and (iii) the MRI evaluation shows a high prevalence of damage, suggesting that joint involvement in SLE could be more severe than expected.
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy. Electronic address: marta.mosca@med.unipi.it.
authors.forename: Marta
authors.initials: M
authors.lastname: Mosca
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Tani
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy; Genomec PhD, University of Siena, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Carli
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Vagnani
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Possemato
authors.affiliation: Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Delle Sedie
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cagnoni
authors.affiliation: Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: D'Aniello
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Riente
authors.affiliation: Diagnostic and Interventional Radiology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Caramella
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bombardieri
mesh_terms: D000328:Adult; D000368:Aged; D050823:Hand Joints / Q000473:pathology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014955:Wrist Joint / Q000473:pathology; D055815:Young Adult
keywords: Arthritis; Erosions; Imaging; MRI; Systemic lupus erythematosus; Ultrasound