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heumatoid arthritis (RA) is an inflammatory rheumatic disease with progressive course affecting articular and extra-articular structures resulting in pain, disability and mortality. It is of unknown etiology, which primarily affects the synovia; where the persisting synovitis of symmetric peripheral joints can lead to structural damage of cartilage, bones, tendons, and ligaments.
The disease affects approximately 1% of the world’s population. Persistent inflammation leads to erosive joint damage and functional impairment in the vast majority of patients. The onset of disease is not similar in all patients but varies in regard to type, number, and the pattern of joint involvement. The course of disease may be also different according to the presence or absence of several variables including genetic background, frequency of swollen joints, autoantibody in the serum and the severity of inflammatory process.
Evaluation of disease activity in rheumatoid arthritis (RA) is essential in the routine clinical management of RA patients and in RA clinical trials. Disease activity in RA joints is conventionally assessed clinically (e.g., assessment of joint swelling/tenderness) in combination with the measurement of levels of biochemical surrogate markers such as serum C-reactive protein.
Up till recent advances in medical management of rheumatoid arthritis, radiographic diagnosis and follow-up of the condition were considered adequate, however, with the increasing use of disease-modifying antirheumatic drugs, early diagnosis is now of paramount importance and disease progression is assessed regularly to monitor efficacy of the treatment. This called for the development of new methods for imaging early joint affection in cases of RA. Newer imaging modalities such as contrast enhanced magnetic resonance imaging (MRI) and high frequency ultrasonography (US) may offer improved monitoring.
Within the last decade the use of ultrasound (US) in the assessment of disease activity in patients with RA has increased considerably. With grey-scale US it is possible to detect morphological changes, e.g. synovial thickening and bone erosions and with Doppler US the blood flow in the synovium and surrounding tissue is demonstrated. The addition of Doppler is important since it is not possible with grey-scale US to distinguish between thickened synovium with inflammation and thickened synovium due to previous attacks. Because increased blood flow is part of the inflammatory response, the presence of hyperaemia may be used to detect inflammation and the amount of Doppler activity may be used as an indirect measure of disease activity in RA.
The aim of this study was to demonstrate the role of Ultrasonography and Power Doppler in to detect and determine early arthritis and to assess and monitor arthritic activity during the course of disease in the hands and wrist joints among different aged population, compared with the laboratory investigations and clinical examination (DAS 28). Moreover, the initial amount of Doppler activity is a prognostic parameter for the development of subsequent bone destruction.
The thirty patients included in this study were diagnosed with rheumatoid arthritis according to the ACR criteria 1987. The clinically dominant wrist and hand joints were examined by power doppler ultrasound study. Synovitis scores were compared and correlated with other signs of inflammation clinically and laboratory.
We found significant correlation and agreement between power Doppler US in the assessment of synovial inflammation in the hand and wrist joints and active form of the disease suspected by clinical examination and laboratory investigation.
This significant correlation indicates the potential importance of power Doppler study in the assessment and monitoring of disease activity as reliable noninvasive method in the hands of skilled operators.