A Study of the Relation Between Clinical Parameters of Rheumatoid Arthritis with Ultrasonographic Findings in Joints and a Comparison of Ultrasonography with Conventional Radiography.

BACKGROUND

Ultrasonography is a safe and effective method which detects synovitis and erosions in joints early, while conventional radiography (CR) detects changes at later stages. These ultrasonographic findings have a relation with clinical parameters which help in predicting outcome.

METHODS

60 patients of diagnosed rheumatoid arthritis (RA) (ACR-EULAR 2010 criteria) were subjected to clinical examination, laboratory investigations, CR and ultrasonography. Data was compiled in Epi Info version 7 software and tests of significance were applied.

RESULTS

Mean tender and swollen joint counts were 18.61+6.51 and 9.56+3.94 respectively. USG detected joint changes in 90% patients while CR could do so in 33.3%. 85% patients with a normal CR had an abnormal USG. On USG, tenosynovitis was found in 48.33% patients, synovial thickening with vascularity in 73.33%, synovial effusion in 40%. USG detected erosions in 14(23.33%) patients, while CR did so in 5(8.33%), a statistically significant finding. 80% of patients with less joint counts had positive USG findings and in them, joints other than those clinically involved were also found affected. Out of 16 patients of early RA who had a normal CR, 87.5% had positive findings on USG. 92.86% of patients having erosions on USG had a positive C reactive protein (CRP). 60.4% patients with synovial thickening had a positive CRP. In all the patients who had erosions on USG, anti CCP levels were of high titre, found to be significant. (P=0.022).

CONCLUSION

USG can detect inflammatory arthritis and synovitis in RA better than CR in both early and established cases. USG findings may be seen in clinically uninvolved joints. Detection of erosions is also significantly better by USG as compared to CR. USG changes correlated with anti CCP and CRP.