Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Use of Musculoskeletal Ultrasound in Diagnosis of Early Inflammatory Arthritis: Are Limited Joint Surveys Adequate?

Sidhu,  Paramvir, Lisse,  Jeffrey, Grau,  Rafael, P. Gall,  Eric, Taljanovic,  Mihra

Objectives:

1. To study the impact of using musculoskeletal ultrasound in diagnosis of early inflammatory arthritis.

2. To examine feasibility of using limited form of musculoskeletal ultrasonography for diagnosis of early inflammatory arthritis without significantly compromising diagnostic accuracy.

Subjects:

Patients with clinical suspicion of inflammatory arthritis but non-diagnostic work up including RF, CCP antibodies, ESR, CRP and plain radiographs.

Methods:

80 patients underwent comprehensive musculoskeletal ultrasound of 22 joints of hands & wrists (bilateral PIP, MCP & wrist joints) from year 2003 to 2010. Parameters analyzed at imaged joints included synovial thickening, increased vascularity and erosions. Retrospective review of this imaging data as well as clinical data including age, sex, serological status (RF & CCP antibody positivity), inflammatory markers (ESR & CRP) and final diagnosis was performed.

Results:

Total Patients80
Clinical Data Available53
Female65
Male15
Age19 to 82 yrs (Median Age = 52)
RF positive6
CCP antibody positive4
Elevated ESR10
Elevated CRP9
 Synovial ThickeningIncreased Vascularity Erosions
JointsRightLeftRightLeftRightLeft
2nd MCP404335332525
3rd MCP323128222117
5th MCP22261512911
Wrist2829263041

There were 48 patients with synovial thickening and increased vascularity and 35 patients with erosions at one or more joints. Changes suggestive of inflammatory arthritis were most commonly seen at 2nd & 3rd MCP and wrist joints. Thirty patients were found to have synovial thickening, 25 increased vascularity and 13 erosions at one or more joints despite having negative RF & CCP antibodies and normal inflammatory markers (ESR & CRP). Fourteen patients were given final diagnosis of inflammatory arthritis primarily based on musculoskeletal ultrasound results and all 14 had synovial thickening and increased vascularity at one or more of 2nd & 3rd MCP and wrist joints.

Conclusions:

1. Musculoskeletal ultrasound is a very useful tool in diagnosis of early inflammatory arthritis in clinical practice.

2. Brief musculoskeletal ultrasound, restricted to just 6 joints (bilateral 2nd & 3rd MCP and wrist joints) instead of 22 joints, can be used to make the diagnosis of early inflammatory arthritis without significantly compromising diagnostic accuracy and thus reducing time required to perform the exam.

To cite this abstract, please use the following information:
Sidhu, Paramvir, Lisse, Jeffrey, Grau, Rafael, P. Gall, Eric, Taljanovic, Mihra; Use of Musculoskeletal Ultrasound in Diagnosis of Early Inflammatory Arthritis: Are Limited Joint Surveys Adequate? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1636
DOI: 10.1002/art.29401

Abstract Supplement

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