Ultrasonographic Abnormalities of Wrist and Metacarpophalangeal Joints in Patients with Systemic Lupus Erythematosus

Abstract

SUMMARY AND CONCLUSION S ystemic lupus erythematosus (SLE) is a rheumatic auto-immune disease characterized by chronic inflammation and autoantibodies. It is a heterogeneous autoimmune disease that may affect different organs and have a variable clinical course. The musculoskeletal manifestations are one of the most common manifestations in SLE. Mostly this involvement is non-erosive and non-deforming arthropathy. The diagnosis of SLE relies on certain characteristic clinical findings in addition to the serological parameters such as antinuclear antibodies (ANA), and in particular antibodies to dsDNA (Anti-ds DNA). The present study was designed to evaluate the role of MSUS in the detection of abnormalities of the wrist and MCP joints and its correlation to clinical examination. This study included (80) female SLE patients who fulfilled the SLICC criteria for SLE classification (Petri et al., 2012). These patients were subdivided according to the presence of hand arthralgia into two groups:  Group I: patients with hand arthralgia.  Group II: patients without hand arthralgia. All of the included patients were subjected to detailed history taking with special emphasis on: age, disease duration, drug intake. Clinical examination including rheumatological examination was done to the patients. Laboratory investigations including CBC, ESR, CRP, ANA, anti-ds DNA, RF, anti-CCP, C3, C4, urinalysis and 42hour urinary protein and lastly both plain radiography on both hands and MSUS examination of both wrist joints and MCP joints were done. In the present study all of the included patients were female (100%), their age ranged between (18-50) years, median SLEDAI score was (5), arthritis was the most common clinical manifestation recorded in the SLICC criteria (67.5%). ANA was positive in all of the patients (100%) and anti-ds DNA was positive in (67.5%) of the patients. By MSUS synovitis was found in (63.75%) of the patients while erosions were detected in only (3.8%) of the patients and no power Doppler signal was detected in any of the patients (0%). Synovitis was most detected at the 2nd MCP joint (33.75%) and least detected in the 5th MCP joint (23.8%). In the present study grade 1 synovitis was found in (62.5%) and grade 2 synovitis in (1.25%) while no grade 3 synovitis was detected by MSUS of the studied patients (0%). In the present study 45 patients complained of hand arthralgia and 35 patients had no complaint of hand arthralgia. Arthritis and lupus nephritis were more reported in patients with hand arthralgia than patients without hand arthralgia. In addition patients with hand arthralgia had higher SLEDAI score with higher markers of disease activity (ESR, CRP and anti-ds DNA titer) and lower levels of complement 3 and 4 then patients without hand arthralgia.