The Validity of Musculoskeletal Ultrasonography Imaging in Diagnosis of Lupus Hand Arthropathy

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune multisystem disorder characterised by frequent musculoskeletal manifestations.Inflammatory musculoskeletal involvement is one of the most common manifestations of SLE. Incidence ranges from 69% to 95% of patients Joint complaints such as arthralgia or arthritis are usually transient, but in some patients they mimic RA, with persistent pain, swelling, stiffness and disability. The most frequently affected joints are the metacarpal–phalangeal, inter-phalangeal, wrist and knee [Grossman et al 2009]. High-resolution ultrasonography has become a useful tool for rheumatologists in the assessment of patients with articular involvement Musculoskeletal US enables real-time evaluation of joints and tendons, especially in assessing the features of synovial or tendon inflammation and bone structural damage [Filippucci ,et al 2009]. The power Doppler (PD) technique enhances the potential of US examination with the evaluation of perfusion changes in the synovial tissue, an indirect sign of active local inflammation [Wakefield et al 2003]. The aim of this study was to assess the usefulness of MSUS in diagnosis of joints and tendons involvement of the hand and wrists in SLE patient. Our study was carried out on 20 patients of Systemic lupus erythamatosus aged from 18 to 55 years. The controls were 20 heathy people any joint affection. The controls were matched in Summary - 102 - age and sex with the cases. All participants were gathered from El Glaa Military FamilY Hospital. All patients included in this study were subjected to: 1- Full history taking. 2- General clinical examination. 3- Local examination with clinical assessment according -systemic lupus erythematosus disease activity index 2000(SLEDAI -2K) 4- Laboratory investigations. 5- Radiological for both wrists and hand joints 6-Muscloskeletal Ultrasonography examination and assessment. The results obtained were statistically analyzed and summarized as follow: • Most of the patient (60%) showed high SLE activity index while only 5%had no activity. • Among our patients 45% showed wrists and hands manifestation in the form of arthalgia ,arthritis OR tenosynovitis, while 55% of the patient were not complaining from any wrist ar hands manifestations. • The laboratory assessment of our patient showed 100% were positive ANA ,70% were positive Anti –dsDNA,25% were positive RF , 20 % were positive Anti-CCP ,35% were positive lupus anticoagulant and 40% were having depletion in complement level.