Gray-scale and color duplex Doppler ultrasound of hand joints in the evaluation of disease activity and treatment in rheumatoid arthritis

Ivanac, Gordana and Morović-Vergles, Jadranka and Brkljačić, Boris (2015) Gray-scale and color duplex Doppler ultrasound of hand joints in the evaluation of disease activity and treatment in rheumatoid arthritis. Croatian Medical Journal, 56 (3). pp. 280-289. ISSN 0353-9504

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Abstract

AIM: To evaluate the role of gray-scale and color duplex-Doppler ultrasound (CDUS) in diagnosis of changes of hand joints and assessment of treatment efficacy in patients with rheumatoid arthritis (RA) by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity. ----- METHODS: Ulnocarpal (UC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints in 30 patients with RA were examined by gray-scale and CDUS before and after six months of treatment. Morphologic and quantitative Doppler findings (synovial thickness, effusion quantity, vascularization degree, resistance index, velocities) were compared with clinical indicators of disease progression: disease activity score (DAS 28), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). ----- RESULTS: Clinical indicators changed significantly after treatment: ESR from 38.1±22.4 mm/h to 27.8±20.9 mm/h (P=0.013), DAS 28 from 5.47±1.56 to 3.87±1.65 (P<0.001), and HAQ from 1.26±0.66 to 0.92±0.74 (P=0.030), indicating therapeutic effectiveness. In all MCP and UC joints we observed a significant change in at least one US parameter, in 6 out of 12 joints we observed a significant change in ≥2 parameters, and in 2 UC joints we observed significant changes in ≥3 parameters. The new finding was that the cut-off values of resistance index of 0.40 at baseline and of 0.55 after the treatment indicated the presence of active disease and the efficacy of treatment, respectively; also it was noticed that PIP joints can be omitted from examination protocol. ----- CONCLUSION: Gray scale and CDUS are useful in diagnosis of changes in UC and MCP joints of patients with RA and in monitoring the treatment efficacy.

Abstract in Croatian

Ultrazvuk sive skale i obojeni dupleks Doppler zglobova ruku u procjeni aktivnosti bolesti i učinkovitosti liječenja reumatoidnog artritisa ----- Cilj: Utvrditi ulogu ultrazvuka sive skale i obojenog dupleks Doppler ultrazvuka (prema engl. color duplex-Dopple ultrasound, CDUS) u dijagnostici promjena na zglobovima ruku i procjeni učinkovitosti liječenja kod pacijenata s reumatoidnim artritisom usporedbom kvalitativnih i kvantitativnih ultrazvučnih parametara i kliničkih i laboratorijskih pokazatelja aktivnosti bolesti. ----- Postupci: Ultrazvukom sive skale i CDUS pregledali smo ulnokarpalne (prema engl, ulnocarpal, UC), metakarpofalangealne (prema engl, metacarpophalangeal, MCP) i proksimalne interfalangealne (prema engl. proximal interphalangeal, PIP) zglobove 30 pacijenata s reumatoidnim artritisom prije liječenja i 6 mjeseci nakon početka liječenja. Usporedili smo morfološke i kvantitativne ultrazvučne nalaze (zadebljanja sinovije, količina izljeva, stupanj vaskularizacije, indeks otpora, brzine) s kliničkim pokazateljima progresije bolesti: Ocjenskom ljestvicom aktivnosti bolesti (prema engl. disease activity score 28, DAS 28), Upitnikom za procjenu zdravlja (prema engl. Health Assessment Questionnaire, HAQ), reumatoidnim čimbenikom (prema engl. rheumatoid factor, RF), sedimentacijom eritrocita (prema engl. erythrocyte sedimentation rate, ESR) i razinom C reaktivnog proteina (CRP). ----- Rezultati: Klinički pokazatelji značajno su se promijenili nakon liječenja: ESR s 38,1 ± 22,4 mm/h na 27,8 ± 20,9 mm/h (P = 0,013), DAS 28 s 5,47 ± 1,56 na 3,87 ± 1,65 (P < 0,001) i HAQ s 1,26 ± 0,66 na 0,92 ± 0,74 (P = 0,030), što je potvrdilo učinkovitost liječenja. Kod svih MCP i UC zglobova primijetili smo značajnu promjenu najmanje jednog ultrazvučnog parametra, kod 6 od 12 zglobova primijetili smo značajnu promjenu u ≥2 parametra, te kod 2 UC zgloba primijetili smo značajnu promjenu ≥3 parametra. Novi nalaz ovog istraživanja je da vrijednost indeksa otpora od 0,40 prije liječenja ukazuje na aktivnu bolest, dok vrijednost od 0,55 nakon liječenja ukazuje na učinkovitost liječenja. Također smo ustanovili da pregled ne mora uključivati PIP zglobove. ----- Zaključak: Ultrazvuk sive skale i CDUS korisni su za utvrđivanje dijagnoze promjena na UC i MCP zglobovima kod pacijenata s reumatoidnim artritisom i za procjenu učinkovitosti liječenja.

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