en POLSKI
eISSN: 2084-9834
ISSN: 0034-6233
Reumatologia/Rheumatology
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5/2021
vol. 59
 
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abstract:
Original paper

Ultrasound detected synovitis, tenosynovitis and erosions in hand and wrist joints: a comparative study between rheumatoid and psoriatic arthritis

Ahmed Ramadan
1
,
Samar Tharwat
1
,
Ahmed Abdelkhalek
2
,
Ehab E Eltoraby
1

1.
Rheumatology and Immunology Unit, Department of Internal Medicine, Mansoura University, Faculty of Medicine, Egypt
2.
Department of Diagnostic Radiology, Mansoura University, Faculty of Medicine, Egypt
Reumatologia 2021; 59, 5: 313–322
Online publish date: 2021/11/01
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Introduction
Musculoskeletal ultrasound (MSUS) has been introduced as a valuable simple imaging tool for arthritis. The objective was to assess the role of ultrasound (US) in the differential diagnosis between rheumatoid arthritis (RA) and psoriatic arthritis (PsA) at the wrist and hand joints and tendons.

Material and methods
Thirty-five patients (20 RA and 15 PsA) with symptomatic involvement of at least one of the hand and/or wrist joints for > 6 weeks were included. Bilateral wrists (distal radioulnar, radiocarpal and midcarpal joints), hands (1st–5th metacarpophalangeal [MCP], 2nd–5th proximal interphalangeal [PIP] and 1st–5th distal interphalangeal [DIP] joints), flexor tendons and extensor compartments at the level of the wrist joint were examined sonographically. Synovial hypertrophy, joint effusion, erosions and tenosynovitis were diagnosed according to Outcome Measures in Rheumatology definitions. The findings were correlated with clinical, laboratory and disease activity indices.

Results
Among 680 and 510 joints examined in RA and PsA respectively, certain US features such as synovitis and erosions at the DIP were exclusively detected in PsA (p < 0.001). Synovitis was frequently detected at the distal radioulnar joints (DRUJ) in RA in comparison to PsA patients (52.5% vs. 26.7% respectively, p = 0.029). Joint effusion was more frequently detected at radiocarpal and midcarpal joints in RA compared to PsA (p = 0.047, 0.039 respectively), whereas erosions were significantly more frequently detected at radiocarpal joints in RA versus PsA patients (45% vs. 20% respectively, p = 0.029). Tenosynovitis was significantly more frequently detected at the extensor tendons in RA and at the flexor tendons in PsA patients (p = 0.021, 0.022 respectively).

Conclusions
There are significant differences in the musculoskeletal US findings of the hand and wrist that joints help to distinguish between RA and PsA.

keywords:

ultrasound, hand, tenosynovitis, psoriatic arthritis, rheumatoid arthritis







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