RESEARCH - Benefits of ultrasound in the management of early arthritis

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Rheumatology Advance Access originally published online on September 15, 2009

Rheumatology 2009 48(12):1515-1519; doi:10.1093/rheumatology/kep279

Benefits of ultrasonography in the management of early arthritis: a

cross-sectional study of baseline data from the ESPOIR cohort

Funck-Brentano1, Fabien Etchepare1, Sandrine J. Joulin2,

Frédérique Gandjbakch1, Valérie D. Pensec2, Cyteval3, Anne

Miquel4, Mathilde Benhamou1, Frédéric Banal1, Xavier Le Loet5, Alain

Cantagrel6, Pierre Bourgeois1 and Bruno Fautrel1

1Department of Rheumatology, Academic Hospital Pitie Salpétrière,

Paris, 2Department of Rheumatology, Academic Hospital La Cavale

Blanche, Brest, 3Department of Radiology, Academic Hospital

Lapeyronie, Montpellier, 4Department of Radiology, Academic Hospital

Bicêtre, Le Kremlin Bicêtre, 5Department of Rheumatology, Rouen

University Hospital and INSERM U905, Rouen and 6Department of

Rheumatology, Academic Hosptial Rangueil, Toulouse, France.

Abstract

Objective. To assess ultrasonography's (US) performance to detect the

structural damage in the initial evaluation of early arthritis (EA)

using the Etude et Suivides Polyarthrites Indifférenciées Récentes

(ESPOIR) cohort.

Methods. ESPOIR is a French, multi-centric EA cohort. Four centres

assessed the structural damage by both X-ray and US examination at

baseline. X-rays of hands and feet were read first by the centre's

local investigator (usual reading), then in the X-ray coordinating

centre (central reading). Four trained examiners performed US blindly

from clinical data to detect erosions on the second and fifth MCP

(MCP2 and 5) and the fifth MTP (MTP5) joints bilaterally.

Results. Patients’ characteristics (n = 126) were: female 78%; mean

age 50.3 years; disease duration 103 days; disease activity score on

28 joints 5; CRP level 22.7 mg/l; and 79.4% of the patients fulfilling

RA ACR criteria. Twelve patients had missing data for X-rays. US

revealed 42 (36.8%) patients with erosive disease, whereas radiography

revealed only 30 (26%) with central reading and only 11% with usual

reading. US missed erosive disease present in X-rays in 10 (8.8%)

patients. Combined technique of both revealed 52 (45.6%) patients with

erosive diseases. On the targeted joints, US detected erosion on 75

(11%) joints vs X-rays on only 11 (1.5%). Only three joints with

erosion(s) detected on X-rays were missed on US. At baseline, the

presence of PD activity was not associated with joint erosions.

Conclusions. US on six joints detected 1.4-fold more patients with

erosions (3.3-fold more with the usual reading). In clinical practice,

US combined with X-rays is of helpful diagnostic value in EA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/12/1515?etoc

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