According to a recent study, ultrasonographic scanning of a patients’ hands provides valuable disease activity information in those suffering with rheumatoid arthritis or systemic sclerosis. The study recently published in The Egyptian Rheumatologist suggests that ultrasonographic articular involvement in systemic sclerosis is less frequent compared to that in rheumatoid arthritis, with specific appearance of sclerosing tenosynovitis in systemic sclerosis patients.
Musculoskeletal ultrasound plays an important role in diagnosing and treating rheumatic diseases. The presence of synovitis in the musculoskeletal ultrasound is useful in the diagnosis of undifferentiated arthritis, and in inflammatory arthritis it is predictive of persistent disease, joint damage, and acute disease flare. In systemic sclerosis (SSc), joint symptoms are reported by 24–97% of patients during the course of their disease. Manifestations of SSc in the hands range from arthralgias to frank arthritis, contractures, and tendon friction rubs. Radiographic studies in SSc and RA show that the joints, soft tissue, and bones of the hands are commonly affected areas. However, radiographs exhibit some limitations regarding their sensitivity to detect early inflammatory changes, such as effusion or synovitis, and they cannot assess tendon damage.
In their study titled “A comparative study between ultrasonographic hand features in systemic sclerosis and rheumatoid arthritis patients: Relation to disease activity, clinical and radiological finding”, Yasser Ezzat from the Rheumatology and Rehabilitation Department at Fayoum University in Egypt and colleagues compared ultrasonographic (US) hand features in both patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA) and tested these findings’ relationship with clinical parameters such as disease activity, clinical and radiographic data.
A total of 40 patients with SSc and 30 patients with RA underwent clinical examination, X-ray and US on the hand and wrist joints to detect synovitis, tenosynovitis, and calcinosis. Results showed that the frequency of synovitis and tenosynovitis detected by the US was higher than that found by clinical examination in both RA and SSc patients. US synovitis was detected in 10 SSc and 17 RA patients. US tenosynovitis was found in 18 SSc patients compared to 11 RA patients. US synovitis and tenosynovitis in RA patients showed a statistically significant correlation with the erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, HAQ-DI and DAS28. Sclerosing tenosynovitis was specific to SSc patients. Results also showed that calcifications were observed in both SSc and RA patients.
Based on these results, the researchers concluded that US is able to provide important disease activity information in both patients with RA and SSc. Compared to RA, US articular involvement in SSc is less frequent with appearance of sclerosing tenosynovitis in patients with SSc.