الفهرس 
List of tablesOnly 14 pages are availabe for public view
 |  | from | 127 |  |  |
| | | from | 127 | | |
Abstract
Rheumatoid arthritis (RA) is one of the most common autoimmune rheumatic diseases, affecting one in 100 individuals worldwide. It is considered a complex systemic multifactorial inflammatory process in which the immune system targets synovial joints and causes mild to severe joint destruction with extra-articular manifestations.
If left untreated, RA leads to deformity, considerable disability, and major comorbid conditions, including cardiovascular disease and increased mortality.
Early treatment with targeted therapies can alter long-term outcomes by minimizing disease activity, preventing joint damage and disability, and improving patients’ quality of life.
The optimal management of RA requires tools that allow early and accurate disease diagnosis, prediction of poor prognosis, and responsive monitoring of therapeutic outcomes.
Traditionally, conventional radiography (CR) has been the imaging modality most frequently used in RA disease assessment. It is useful in detecting bony structural abnormalities such as erosions, periarticular osteopenia, and joint space narrowing (JSN), but it is not sensitive in detecting RA joint structural changes, especially in early disease assessment.
Accordingly, the more sensitive imaging modalities such as ultrasound (US) and MRI have become increasingly required.
Musculoskeletal US can demonstrate synovial fluid effusion and synovial thickening with a greater sensitivity than clinical examination. Ultrasound reflects not only disease activity but also the disability status and structural joint damage.
Unlike MRI, Ultrasound is more available in many centers and has fewer financial constraints and requires less time for examination relative to MRI.
This work aimed to determine the diagnostic value of hand ultrasound in patients with rheumatoid arthritis, particularly in early disease.
This was a prospective study that was conducted at Sohag University Hospital on 30 cases with rheumatoid arthritis.
Summary of our results:
This study includes 30 patients aged 19 to 58 years with a mean age of 42.13 years. Females represented 80% of studied patients. About 73% were housewives/non-workers and 70% came from rural residences.
Number of tender joints ranged from 0 to 16 with median 3. Number of swollen joints ranged from 0 to 9 with median 1 joint.
Regarding laboratory data, positive RF was reported in 90%.
Positive CRP was reported in 46.7%. ESR ranged from 10 to 100 mm/hr with median 28 mm/hr.
Concerning DAS28 score, it ranged from 2.04 to 7.05 with mean 4.15 ± 1.49. Remission was reported in 16.7%, mild activity in 20%, moderate activity in 36.7% and high activity in 26.7%.
Concerning ultrasonographic findings of patients, 36.7% of patients had two joints with grade 1 synovitis, while 53.3% of patients had no joint with grade 2 synovitis, 66.7% of patients had no joint with synovitis grade 3. About 23% had 4 to 7 joints with synovial thickening grade 1, 36.7% of patients had one joint with synovial thickening grade 2, 6.7% of patients had 2 – 7 joints with synovial thickening grade 3. No joint effusion was reported in 66.7% of patients, 70% of patients had no tenosynovitis while 23.3% had no erosion.
There was statistically significant difference between DAS28 and VAS. on doing pairwise comparison, the difference is significant between high activity and all of remission, moderate and mild activity. Also, difference was significant between moderate activity and remission.
There was statistically non-significant difference between clinical activity assessed by DAS28 and number of joints with grade 1 synovial thickening. There was a statistically significant difference between clinical activity assessed by DAS28 and number of joints with grade 2 synovial thickening. There was a statistically significant difference between clinical activity assessed by DAS28 and number of joints with grade 3 synovial thickening. On doing pairwise comparison, the difference is significant between high and moderate activity. Also, between high activity and both remission and mild activity.
There was a statistically significant difference between clinical activity assessed by DAS28 and joint effusion. On doing pairwise comparison, the difference is significant between high activity and both moderate and mild activity. There was a statistically significant difference between clinical activity assessed by DAS28 and tenosynovitis. On doing pairwise comparison, the difference is significant between high activity and all of remission, mild, and moderate activity. The difference is also significant between mild and moderate activity.
There was a statistically significant difference between clinical activity assessed by DAS28 and the number of joints with synovitis. On doing pairwise comparison, the difference is significant between remission and moderate activity and also between high activity and each other group.
There was statistically significant difference between clinical activity assessed by DAS28 and number of joints with synovial thickening. On doing pairwise comparison, the difference is significant between high and moderate activity. Also, between high activity and each other group.
There was a statistically significant difference between clinical activity assessed by DAS28 and erosion. On doing the pairwise comparison, the difference is significant between high activity and both remission and mild, activity. The difference is also significant between remission and moderate activity.
There was a statistically significant positive correlation between DAS28 and the number of joints with synovitis grade 1, 2, and 3, synovial thickening grade 2 and 3, tenosynovitis, and erosions. There was a statistically non-significant positive correlation between DAS28 and the number of joints with synovial thickening grade 1 and joint effusion.
There was a statistically significant positive correlation between VAS and the number of joints with synovitis grade 1, 2, and 3, synovial thickening grade 1, 2, and 3, tenosynovitis, and erosions.
There was a statistically significant difference between clinical activity assessed by DAS28 and the number of tender joints, swollen joints, and number of total joints detected by clinical examination. There is a statistically significant difference between clinical activity assessed by DAS28 and the number of total joints detected by ultrasound examination. On doing the pairwise comparison, the difference is significant between groups with mild and both high and moderate activity. Also, the difference is significant between high activity and all remission.
There is a statistically significant positive correlation between the number of joints affected by clinical examination and by US examination. The agreement is good between the number of joints affected by clinical examination and by US examination. There is good reliability between them.
There was a statistically significant difference between remission assessed by DAS28 and the number of joints with synovitis, synovial thickening, erosion detected by the US, and number of tender and swollen joints as detected clinically. There was non-significant relation between it and ultrasonographic findings of joint effusion or tenosynovitis. According to US findings, only one patient was on remission.
There are three patients with no tender or swollen joints by clinical examination but they had numerous lesions on US examination.
Positive signs of disease activity on DAS28 can predict activity as proven by US by sensitivity 86.2%, 100% specificity, positive predictive value 100%, negative predictive value 20% and overall accuracy 86.7%.
Positive signs of disease activity on clinical examination can predict activity as proven by US by sensitivity 89.7%, 100% specificity, positive predictive value 100%, negative predictive value 25% and overall accuracy 90%.
Conclusion
Our findings suggested that both clinical examination and DAS28 scores are useful tools for assessing disease activity in patients with RA, but that ultrasound may be necessary to confirm disease activity in patients with negative clinical or DAS28 findings.
Recommendations
We recommend the need to have more work in this point to raise the role of involving US joints assessment in RA within the disease activity score.
Further research is needed to investigate the optimal use of hand ultrasound in the assessment of RA, including its role in disease monitoring, treatment decision-making, and prediction of radiographic progression.
Operator training and certification in hand ultrasound should be established to ensure that operators are appropriately trained and have a standardized level of competency.