Ultraschall Med 2004; 25 - WS_06A_02
DOI: 10.1055/s-2004-834039

Long-term follow-up imaging study comparing clinical examination, ultrasound and radiography in rheumatoid arthritis finger joints

AK Scheel 1, KG Hermann 2, S Ohrndorf 3, C Werner 4, J Fritz 5, GA Müller 3, GR Burmester 5, M Backhaus 5
  • 1Nephrologie-Rheumatologie, Göttingen
  • 2Radiologie, Charité Berlin
  • 3Nephrologie-Rheumatologie
  • 4Medizinische Statistik, Uni Göttingen
  • 5Rheumatologie, Charité Berlin

Problemstellung: To compare clinical examination (CE), conventional radiography (CR) and ultrasound (US) in the detection of bone erosions and synovitis in rheumatoid arthritis (RA) finger joints in a long-term follow up study. In addition, to determine whether radiographically occult finger joint erosions – previously detected by US – would present on conventional radiographs seven years later.

Methode: After 7 years, follow-up examination of 16 patients with RA (11 female, 5 male) was performed with radiography and US. Patients were examined at baseline and at follow-up visit (mean duration 6.8 years). The metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints II-V (8 joints, total: 128 joints) of the clinically dominant hand were included in the study. Follow-up comparisons for erosions and synovitis were performed in a joint by joint manner.

Ergebnisse: At baseline, 4% erosions of all examined finger joints were detected by radiography, 9% by US. 7 years later, a significant increase of joints with erosions was found with radiography (26%) and US (49%) (p<0.001 each). In contrast, CE tenderness showed a significant decrease from 40% to 18% of the examined joints at follow-up (p<0.002). We saw a significant reduction of synovitis with US (p<0.001); however, there was no significant difference in synovitis reduction assessed by CE. In radiography, 12 of 16 patients did not have any erosions at baseline. In 10 of the 12 patients (83%) erosions were detected after 7 years in 25 of the 96 joints (26%). US initially detected erosions in 9 joints, of which 2 erosions showed up in radiography at follow-up.

Schlussfolgerung: Despite clinical improvement and a regression of synovitis under DMARD treatment, we saw a remarkable increase of erosive bone lesions with both, US and radiography after 7 years. However, increase of bone erosions was more distinct using CR compared to US.