title: In arthritis the Doppler based degree of hypervascularisation shows a positive correlation with synovial leukocyte count and distinguishes joints with leukocytes greater and less than 5/nL.
abstract: OBJECTIVE
  Power Doppler ultrasound is used to assess joint vascularity in acute arthritis. PDUS signals have been correlated with synovial histology and bone deterioration. Little is known about the correlation between power Doppler signals and synovial white blood count. In our study, we analyzed power Doppler signals in inflammatory joint diseases including gout, calcium pyrophosphate deposition disease, rheumatoid arthritis, spondyloarthritis and others and correlated power Doppler signals with synovial white blood count and with serologic markers of inflammation.
  
  
  METHODS
  We retrospectively evaluated 194 patients with arthritis. All patients underwent joint sonography, power Doppler ultrasound, synovial fluid analysis and blood examination of C-reactive protein and erythrocyte sedimentation rate. Correlation analyses (Spearman and Pearson), Chi(2) test, t-tests, a unifactorial ANOVA and regression analyses were applied.
  
  
  CONCLUSIONS
  Hypervascularisation in power Doppler was most prominent in gout and calcium pyrophosphate deposition disease. Spondyloarthritis and non-inflammatory joint diseases presented with low degrees of hypervascularisation. Mean synovial white blood count did not differ significantly between crystal-related arthritides, rheumatoid arthritis, spondyloarthritis or other inflammatory joint diseases. There was a positive but weak correlation between power Doppler signals and synovial white blood count (P<0.001, rs=0.283), erythrocyte sedimentation rate (P<0.001, rs=0.387) and C-reactive protein (P<0.001, rs=0.373) over all diagnoses. This was especially relevant in rheumatoid arthritis (P<0.01, rs=0.479). Power Doppler degrees 0 and 1 were able to predict synovial leukocytes<5/nL, degrees 2 and 3 predict leukocytes≥5/nL (P<0.001).
authors.affiliation: Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany; Department of Nephrology, Hypertensiology, Rheumatology, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Electronic address: christianloeffler@gmx.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Löffler
authors.affiliation: Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sattler
authors.affiliation: Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Peters
authors.affiliation: Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany.
authors.forename: Anika
authors.initials: A
authors.lastname: Tuleweit
authors.affiliation: Center of Psychological Psychotherapy, University of Heidelberg, Bergheimerstr. 58a, 69155 Heidelberg, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Löffler
authors.affiliation: Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wadsack
authors.affiliation: Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uppenkamp
authors.affiliation: Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany; Department of Nephrology, Hypertensiology, Rheumatology, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Raoul
authors.initials: R
authors.lastname: Bergner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000000981:diagnostic imaging* / Q000276:immunology*; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013582:Synovial Fluid / Q000276:immunology*; D018608:Ultrasonography, Doppler; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Arthritis; CPPD; Gout; Joint sonography; Power Doppler ultrasound; Rheumatoid arthritis; Synovial leukocytes