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Joint positions matter for ultrasound examination of RA patients—increased power Doppler signal in neutral versus flat position of hands

Published on Aug 1, 2017in Rheumatology5.149
· DOI :10.1093/RHEUMATOLOGY/KEX153
Rusmir Husic7
Estimated H-index: 7
(University of Graz),
Angelika Lackner5
Estimated H-index: 5
(University of Graz)
+ 2 AuthorsChristian Dejaco29
Estimated H-index: 29
(University of Graz)
Abstract
Abstract Position of joints might influence the result of US examination in patients with RA. The purpose of this work was to compare grey-scale (GS) and power Doppler (PWD) findings obtained in neutral vs flat position of hands. A cross-sectional study of 42 RA patients with active disease. Two dimensional and 3D sonography of wrists and MCP joints were conducted in two different joint positions: neutral position, which is a slight flexion of the fingers with relaxed extensor muscles; and flat position, where all palm and volar sides of fingers touch the Table. Two dimensional GS synovitis (GSS) and PWD signals were scored semi-quantitatively (0-3). For 3D sonography, the percentage of PWD voxels within a region of interest was calculated. GSS was not quantified using 3D sonography. Compared with neutral position, 2D PWD signals disappeared in 28.3% of joints upon flattening. The median global 2D PWD score (sum of all PWD scores of an individual patient) decreased from 8 to 3 ( P
  • References (32)
  • Citations (2)
References32
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#2Richard J. Wakefield (University of Leeds)H-Index: 58
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Objectives To study the responsiveness of a combined power Doppler and greyscale ultrasound (PDUS) score for assessing synovitis in biologic-naive patients with rheumatoid arthritis (RA) starting abatacept plus methotrexate (MTX). Methods In this open-label, multicentre, single-arm study, patients with RA (MTX inadequate responders) received intravenous abatacept (∼10 mg/kg) plus MTX for 24 weeks. A composite PDUS synovitis score, developed by the Outcome Measures in Rheumatology–European League...
41 CitationsSource
#1James Dale (Wishaw General Hospital)H-Index: 8
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Objective To investigate whether an intensive early rheumatoid arthritis (RA) treat-to-target (T2T) strategy could be improved through the use of musculoskeletal ultrasound (MSUS) assessment of disease activity. Methods 111 newly diagnosed patients with RA or undifferentiated arthritis (symptom duration Results Groups were matched for baseline clinical, demographic and radiographic features. The intervention group received more intensive DMARD therapy. Both groups demonstrated significant improv...
85 CitationsSource
#1Mads Ammitzbøll-Danielsen (UCPH: University of Copenhagen)H-Index: 3
#2Iustina Janta (Hospital General Universitario Gregorio Marañón)H-Index: 5
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Background The aim was to investigate the presence of feeding vessels in or in close proximity to extensor and flexor tendon sheaths at the wrists level and in finger flexor tendon sheaths in healthy controls, using 3D ultrasound (US), which may cause pitfalls, in order to ensure correct interpretation of Doppler signals when diagnosing tenosynovitis.
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#1Wolfgang A. SchmidtH-Index: 39
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#1Peter P. CheungH-Index: 18
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12 CitationsSource
#1Annamaria Iagnocco (Sapienza University of Rome)H-Index: 42
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Objective. To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Task Force on the validity of different US measures in rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) presented during the OMERACT 11 Workshop. Methods. The Task Force is an international group aiming to iteratively improve the role of US in arthritis clinical trials. Recently a major focus of the group has been the assessment of responsiveness of a person-level US syno...
34 CitationsSource
#1Pascal ZuffereyH-Index: 15
#2Giorgio TamborriniH-Index: 14
Last. Hans Rudolf ZiswilerH-Index: 6
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Ultrasound (US) has become a useful tool in the detection of early disease, differential diagnosis, guidance of treatment decisions and treatment monitoring of rheumatoid arthritis (RA). In 2008, the Swiss Sonography in Arthritis and Rheumatism (SONAR) group was established to promote the use of US in inflammatory arthritis in clinical practice. A scoring system was developed and taught to a large number of Swiss rheumatologists who already contributed to the Swiss Clinical Quality Management (S...
20 CitationsSource
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14 CitationsSource
#1Alexandra N. Colebatch (University Hospital Southampton NHS Foundation Trust)H-Index: 6
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Objective To develop evidence-based recommendations on the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA). Methods The task force comprised an expert group of rheumatologists, radiologists, methodologists and experienced rheumatology practitioners from 13 countries. Thirteen key questions on the role of imaging in RA were generated using a process of discussion and consensus. Imaging modalities included were conventional radiography, ultrasound, MRI, CT, dua...
295 CitationsSource
#1Lene Terslev (Copenhagen University Hospital)H-Index: 38
#2Karen Ellegaard (Copenhagen University Hospital)H-Index: 14
Last. Søren Torp-Pedersen (Copenhagen University Hospital)H-Index: 34
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Objective. To evaluate the reliability and agreement of semi-quantitative scoring (SQS) and quantitative scoring (QS) systems. To compare the two types of scoring system and investigate the construct validity for both scoring systems. Methods. A total of 46 RA patients (median disease duration of 6.5 years) were enrolled in the study. They were investigated with colour Doppler ultrasound using the central position of the wrist. Disease activity score based on 28 joints (DAS-28) was determined fo...
20 CitationsSource
Cited By2
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#1Peter Mandl (Medical University of Vienna)H-Index: 20
#2Emilio Filippucci (Marche Polytechnic University)H-Index: 50
Last. Peter V. BalintH-Index: 38
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The wrist and the small joints of the hand are among the most frequently involved anatomical sites in rheumatic and musculoskeletal diseases (RMDs). Consequentially, they are also frequently evaluated by sonographers both in routine clinical practice and within the framework of clinical trials, providing an opportunity for rheumatologists performing ultrasound to gain a deeper understanding of the pathological processes involved in rheumatic diseases. We provide an extensive introduction into th...
Source
#1Ingrid Möller (University of Barcelona)H-Index: 27
#1I Moeller (University of Barcelona)H-Index: 1
Last. Esperanza NaredoH-Index: 45
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Background In 2001, the European League Against Rheumatism developed and disseminated the first guidelines for musculoskeletal (MS) ultrasound (US) in rheumatology. Fifteen years later, the dramatic expansion of new data on MSUS in the literature coupled with technological developments in US imaging has necessitated an update of these guidelines. Objectives To update the existing MSUS guidelines in rheumatology as well as to extend their scope to other anatomic structures relevant for rheumatolo...
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