title: Synovial Inflammation Drives Structural Damage in Hand Osteoarthritis: a Narrative Literature Review.
abstract: BACKGROUND
  Ultrasound is one of the most promising candidates for the detection of inflammation and structural damage in hand osteoarthritis.
  
  
  OBJECTIVE
  To evaluate new advances of US as a diagnostic and prognostic tool in hand osteoarthritis assessment.
  
  
  METHODS
  We conducted a Medline on PubMed search for articles about "ultrasonography" and "hand OA" published between January 2012 and 15th April 2016, limiting our search to articles on human adults in English, excluding those involving systemic inflammatory diseases, visualization of joints other than hands, ultrasound guided injections and surgical procedures. Reviews, case reports, letters, position statements and ex vivo studies were excluded. Concordance between ultrasound and conventional radiography and magnetic resonance imaging was evaluated.
  
  
  RESULTS
  Total 46 records were identified, and 16 articles were selected: four showed only ultrasound structural damage (osteophytes, cartilage pathology), six only ultrasound inflammatory variables (synovial thickness, effusion and power Doppler signal), six should considered both ultrasound structural and inflammatory features as well as erosions and two were epidemiological studies. Ultrasound synovitis and power Doppler signal were more frequent in erosive hand osteoarthritis. Followup studies found that ultrasound inflammatory features at baseline are independently associated with radiographic progression; power Doppler signal was the strongest predictor of structural damage. Ultrasound is a reliable tool for cartilage and osteophyte assessment (when performed with static images) and shows a good concordance with magnetic resonance imaging for osteophytes, erosions and synovitis.
  
  
  CONCLUSIONS
  Ultrasound detected inflammation may predict radiographic progression and may be used in prospective clinical trials of hand osteoarthritis and in everyday clinical practice.
authors.affiliation: SSD Medicine & Rheumatology, Orthopaedic Rizzoli Institute, Via Pupilli 1, 40136 Bologna,. Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Mancarella
authors.forename: Olga
authors.initials: O
authors.lastname: Addimanda
authors.forename: Carlotta
authors.initials: C
authors.lastname: Cavallari
authors.forename: Riccardo
authors.initials: R
authors.lastname: Meliconi
mesh_terms: D050823:Hand Joints / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000473:pathology; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000473:pathology*; D013585:Synovitis / Q000000981:diagnostic imaging / Q000473:pathology; D018608:Ultrasonography, Doppler / Q000379:methods
keywords: Ultrasound; erosions; hand osteoarthritis; inflammation