Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects I - Renal, Malignancy, Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: Patients with systemic lupus erythematosus (SLE) frequently encounter problems of musculoskeletal origin including arthralgia, tenosynovitis and arthritis in varying degrees of severity. Some patients develop hand deformities probably because of undetected inflammation in joints and tendons. Data on the sensitivity of clinical joint examination and inter-observer reliability of the Ultrasound (US) findings in SLE patients are limited. We aimed to determine 1) US findings in patients with SLE with and without clinical symptoms of arthritis in the hand and to compare findings with clinical evaluation 2) to determine the inter-observer reliability of the US findings.
Methods:
Thirty-three female SLE patients with or without hand arthralgia (HA) at time of examination were included. They were examined twice by US by 3 trained examiners. B-mode and Doppler examination was performed of the wrist and MCP joints for synovitis and erosions and the extensor and flexor tendons at the wrist level for signs of tenosynovitis using a GE Logiq 9 US machine with Doppler settings for slow flow. All patients underwent clinical joint evaluation and were compared to 11 healthy controls (CTRLs).
Results:
Among the 33 SLE patients 16(48%) had wrist synovitis +/-Doppler activity on US which was only observed in 1 CTRL (9%) (p=0.03). Corresponding figures for any mcp joint were 12(36%) and 0(0%) (p=0.02). In 21% of the SLE patients tenosynovitis was found and in 6% bone erosions in hands. Wrist synovitis +/-Doppler activity was observed significantly more in SLE patients (81%) with arthralgia in hands at time of US examination compared to patients with no symptoms (18%) (p=0.0005), for MCP joints this was 63% and 12% (p=0.0071), respectively. US findings were observed in 44% of 25 wrists of SLE patients with no tenderness at clinical examination and in 46% of 26 wrists with no swelling. Corresponding figures for 2mcp joints were 27% and 21%. The inter-observer reliability was good to excellent for MCP joints, wrists and tendons.
Conclusion:
A majority of SLE patients with arthralgia in hands have US signs of synovitis, erosions and tenosynovitis indicating subclinical disease. Clinical joint examination underestimates synovitis in SLE patients compared to US examination. Good to excellent agreement for inter-observer reliability was found in US evaluation of hand joints in SLE patients. These results indicate that US examination of hand is a clinically reliable and sensitive diagnostic modality in SLE.
Disclosure:
L. Dreyer,
None;
S. Jacobsen,
None;
L. Juul,
None;
L. Terslev,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonographic-findings-and-inter-observer-reliability-in-danish-patients-with-systemic-lupus-erythematosus-a-comparison-with-clinical-examination-of-wrist-and-hand-joints/