الفهرس 
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Abstract
This study was performed to evaluate wrist and hand joints in patients with RA by using Power Doppler Ultrasonography and study the association between ultrasonographic findings, clinical variables and scores of disease activity.
The study was a cross-sectional study that included 50 RA patients diagnosed according to the classification criteria of the 2010 ACR/EULAR for RA. All patients were subjected to full clinical and laboratory investigations. The MHAQ was assessed in the patients. Disease activity was calculated using DAS28 and CDAI. The ultrasonographic examination included the wrist, metacarpophalangeal and proximal interphalangeal joints of the hand. Greyscale was used to study synovial hypertrophy and PD to assess synovial vascularity. The association between disease activity assessed by DAS28, CDAI and ultrasonography was also studied. The MHAQ assessed the functional ability of the patients in performing daily living activities. Also,the correlation between the MHAQ score and ultrasonography was studied.
This study demonstrated the following:
The majority of cases (68%) were active (moderate and severe disease activity) as identified by DAS-28, (32%) of patients were controlled on medications (remission or low disease activity). The mean DAS28 score was 4.4±1.4, the mean CDAI was 17.4±13.6, and the mean MHAQ score was 1.03; 90% of cases had variable degrees of functional disability.
Synovial hypertrophy was detected in 92% of patients, mainly in the wrist and 2nd MCP joints. Power Doppler Signals (PDUS) were found in 90% of cases, especially in wrist and 2nd MCP joints and only (8%) of patients had normal synovium.
Ultrasound detection of synovitis was shown to be more frequent than clinical examination. However, there were 18% of patients with RA in clinical remission (DAS28≤ 2.6), only 10% of cases had no PD –Signals (sonographic or deep remission).
There was a significant correlation between the higher degrees of functional disability evaluated by the MHAQ score and both synovial hypertrophy(p = 0.003) and PD –Signals of the hand joints detected by the US (p < 0.001).
There was a statistically significant association between the higher DAS28 score and both synovial hypertrophy of 2nd MCP, 2nd, 3rd, 4th PIP joints (p = 0.009), higher grades of power Doppler in 2nd, 3rd, 4th, 5th MCP 2nd, 3rd, 5thPIP joints (p <0.001).
Also, there was a significant linear positive association between the higher CDAI score and both synovial hypertrophy of 2nd MCP, 2nd, 3rd, and 4th PIP joints(p = 0.002), higher grades of power Doppler in 2nd, 3rd, 4th, 5th MCP 2nd, 3rd, 5thPIP joints (p < 0.001).
There was a positive correlation between high grades of PD, ESR (p = 0.003), CRP (p = 0.005), Anemia (P = 0.048) and Anti-CCP antibodies (P = 0.03). There was no significant association between PD activity , and both Thrombocytosis , Rheumatoid Factor.