Sonographic and Duplex Evaluation of Synovial activity in Wrist and Hand Joints in Rheumatoid Arthritis

Abstract

Rheumatoid Arthritis is a chronic inflammatory immune mediated disorder where synovial proliferation, pannus formation and bone erosions are histological hallmarks, initially affects small joints, progressing to larger joints , this raise the importance for the assessment of the disease activity and severity particularly in patients with well-characterised risk factors for poor outcomes such as high disease activity, presence of autoantibodies, and early joint damage to enable therapeutic decisions and to evaluate disease outcome and response to treatment . Clinical evaluation of joint pain and swelling has not been enough, and conventional plain radiography depicts indirect signs of cartilage loss and bony erosions , MSKUS beyond the capability of plain radiographs and the clinical exam. Ultrasound is non invasive, relatively cheap and widely accessible imaging tool that facilitates the detection of synovitis and erosions more better than clinical, laboratory investigations alone . It can also evaluate joint effusion and thickening of synovium can be quantified. Furthermore, high resolution gray scale images combined with Doppler technique have made it possible to detect slow low volume blood flow, opening new avenues for detecting and grading inflammation in joints We propose in this study that the use of musculoskeletal ultrasonographical examination could be a reliable method for improving the outcome of the standard clinical assessment in Rheumatoid synovial inflammation, the correlations between the clinical disease activity indices, laboratory investigations, duration of illness and components of the US findings reflected the value of US in assessment Of disease activity and severity, the combination of GSUS and PD Could be used as non-invasive and widely available method complementary to standard clinical assessment for evaluating rheumatoid synovial inflammation in daily management.