Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis

[Guest guest]

Arthritis Rheum. 2004 Jul;50(7):2103-12.

Ultrasonography of the metatarsophalangeal joints in rheumatoid

arthritis: Comparison with magnetic resonance imaging, conventional

radiography, and clinical examination.

Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS,

OStergaard M.

University of Copenhagen Hvidovre Hospital, Hvidovre, Denmark.

OBJECTIVE: To compare ultrasonography (US) with magnetic resonance

imaging (MRI), conventional radiography, and clinical examination in the

evaluation of bone destruction and signs of inflammation in the

metatarsophalangeal (MTP) joints of patients with rheumatoid arthritis

(RA). METHODS: Two hundred MTP joints of 40 patients with RA and 100 MTP

joints of 20 healthy control subjects were assessed with B-mode US,

contrast-enhanced MRI, conventional radiography, and clinical

examination for signs of bone destruction and joint inflammation.

RESULTS: With MRI considered the reference method, the sensitivity,

specificity, and accuracy of US for the detection of bone erosions were

0.79, 0.97, and 0.96, respectively, while the corresponding values for

radiography were 0.32, 0.98, and 0.93. The sensitivity, specificity, and

accuracy of US for the detection of synovitis were 0.87, 0.74, and 0.79,

while for clinical examination, the corresponding values were 0.43,

0.89, and 0.71. Erosive disease was identified in 26 patients by US,

compared with 20 patients by MRI and 11 patients by radiography.

Evaluation by US indicated signs of inflammation in 36 patients, while

MRI and clinical examination revealed signs of inflammation in 31

patients and 20 patients, respectively. US and MRI volume-based gradings

of synovitis showed intraclass correlation coefficients of 0.56-0.72 (P

< 0.0001). The MRI and radiographic visualizations of US-detected bone

changes were closely related to their size-based gradings on US.

CONCLUSION: US enables detection and grading of destructive and

inflammatory changes in the MTP joints of patients with RA. By

comparison with MRI, US was found to be markedly more sensitive and

accurate than clinical examination and conventional radiography.

Considering the early and frequent involvement of the MTP joints,

evaluation of these joints by US may be of major clinical importance in

RA.

PMID: 15248207

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org