Session Information
Title: Imaging of Rheumatic Diseases I: Imaging in Gout, Pediatric, Soft and Connective Tissue Diseases
Session Type: Abstract Submissions (ACR)
Background/Purpose:
A previous ultrasound study of the hands in scleroderma (SSC) and rheumatoid arthritis (RA), found mild inflammatory changes in the tendons and joints of the SSC patients. Our aim was to evaluate joints, tendons and subcutaneous tissue in SSC patients compared to RA patients and healthy controls (HC).
Methods:
A total of 74 SSC patients and 14 HC were examined in this cross sectional study and compared to a database of 32 RA patients. The patients underwent clinical and laboratory assessment. Blinded US exam of 13 joints (Wrist, MCPs 2-5, PIPs 2-5,DIPs 2-5) was performed, using GE logic E9 scanner with a linear array (5-16 MHz). Gray scale (GS) (0-1) and Power Doppler (PD) (0-3) scoring were used for tendons. GS and PD (0-3) scoring were used to evaluate joints. In 13 patients, we were unable to examine all 13 joints due to contractures. We therefore calculated separate GS and PD scores for joints and tendons by summing up scores for individual joints and dividing it by the number of joints examined. Subcutaneous tissue over the dorsal aspect of the MCPs was evaluated by PD (SCPD). Tuft resorption was examined by evaluating shortening of the distal second to fifth phalanges on the palmar and dorsal aspects. RA patients only had data on 5 joints (wrist, MCPs 2-3 and PIPs 2-3) and this subset was compared across the groups.
Results:
Mean age was similar between all 3 groups. Percentage of females was 82, 90, and 71 for SSC, RA and HC respectively. Mean disease duration was 6.9 and 5.7 in the SSC and RA patients (Table 1). Mean DAS28 and CDAI in the RA patients was 5.07 and 22 respectively. For SSC patients 13.5% had tuft resorptions compared to none of the RA patients and HC. Mean GS and PD score for joints and tendons of the 13 joints exam were significantly higher in the SSC patients then HC (mean joint GS 0.33 and 0.08, mean join PD 0.07 and 0.01, mean tendon GS 0.08 and 0, mean tendon PD 0.09 and 0 for the SSC and HC respectively, p<0.05 for all) . For the 5 joint exam, mean GS and PD for tendons and joints was significantly higher in the SSC versus HC as well as RA patients except PD for tendons which was not significant in the SSC compared to HC. RA patients had a higher frequency of +2 or +3 PD in joints and tendons while HC had none (Table 1). Twenty one percent of SSC patients with swollen joint count of zero, had +2 or +3 PD signals in joints or tendons. Subcutaneous PD signals were found nearly exclusively in SSC patients.
Conclusion:
Joint and tendon inflammation in scleroderma is increased compared to HC but milder then in RA. US detected synovitis more frequently than physical examination in the SSC patients. Since it is sometimes difficult to estimate synovitis on physical examination in SSC patients due to tight skin and contractures, US would be useful in the assessment of synovitis in these patients.
Ref.
1. Elhai M et al. Arthritis Care Res 2012.
|
|
Age |
% F |
Disease duration (y) |
Mean ESR |
5 Joint GS
|
5 Joint PD |
5 Tendon GS |
5 Tendon PD |
% patients with +2 or +3 join PD |
% Patients with +2 or +3 Tendon PD |
% SCPD (N) |
|
SSC (N=74) |
53.46 |
82 |
6.9 |
18.6 |
0.42 |
0.09 |
0.11 |
0.1 |
16 |
24 |
22 (17) |
|
RA (N=32) |
53.75 |
90 |
5.7 |
39.6 |
1 |
0.52 |
0.33 |
0.41 |
93 |
62 |
0.03 (1) |
|
HC (N=14) |
52.2 |
71 |
NA |
NA |
0.08 |
0.004 |
0.01 |
0 |
0 |
0 |
0 |
|
Total P value |
0.97
|
0.26
|
0.012
|
0.0013
|
<0.01
|
<0.01
|
<0.01
|
<0.01
|
<0.01
|
<0.01
|
<0.01
|
|
SSC-RA P value |
NA |
NA |
NA |
NA |
<0.01
|
<0.01
|
<0.01
|
<0.01
|
<0.01
|
0.0003
|
0.0113
|
|
SSC-HV P value |
NA |
NA |
NA |
NA |
<0.01
|
0.0328
|
0.0133
|
0.0662
|
0.208
|
0.0642
|
0.0459
|
HC-Healthy controls, SSC-scleroderma, SCPD- subcutaneous power Doppler , PD-Power Doppler, GS-gray scale, F-females, NA-not applicable
Disclosure:
A. Scheiman-Elazary,
None;
A. Ben-Artzi,
None;
S. Kafaja,
None;
V. Ranganath,
None;
N. Borazan,
None;
P. J. Clements,
None;
D. Furst,
AbbVie,
2,
Actelion Pharmaceuticals US,
2,
Amgen,
2,
BMS,
2,
Gilead,
2,
GSK,
2,
NIH,
2,
Novartis Pharmaceutical Corporation,
2,
Pfizer Inc,
2,
Roche/Genentech,
2,
UCB,
2,
Janssen Pharmaceutica Product, L.P.,
5.
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