Danish Medical Bulletin - No. 1. February 2004. Vol. 51 Page 151.

Ultrasonography of
the finger and toe joints
in rheumatoid arthritis

Marcin Szkudlarek

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This PhD dissertation was accepted by the Faculty of Health Sciences of the University of Copenhagen, and defended on November 14, 2003.

Official opponents: Jan Pødenphant, Wolfgang Schmidt, Germany, and Michael Bachmann Nielsen.

Tutors: Henrik S. Thomsen, Mikkel Østergaard, Mette Klarlund, and Michel Court-Payen.

Correspondence to: Marcin Szkudlarek, Reumatologisk klinik 232, Medicinsk Center, H:S Hvidovre Hospital, Kettegård Allé 30, DK-2650 Hvidovre.

Dan Med Bull 2004;51:151.

ABSTRACT

This PhD study, carried out at the Departments of Rheumatology and Radiology, and the Danish Research Centre of Magnetic Resonance, University of Copenhagen H:S Hvidovre Hospital in the period 2000-2002, is based on the results of three studies and two substudies.

The purpose of the PhD study was to investigate, by comparison with magnetic resonance imaging (MRI), plain film radiography (CR) and clinical examination, if ultrasonography (US) could be used to detect and grade destructive and inflammatory changes in rheumatoid arthritis (RA) finger and toe joints.

The new aggressive treatment strategy in RA, aiming at fast and effective suppression of inflammation, demands sensitive and specific methods for detection of disease signs and monitoring of disease activity. The small joints of the hands and feet are frequently involved in early RA, and evaluation of these joints is consequently of particular importance.

The methods currently used, such as clinical examination, biochemical assessment and CR, are neither sensitive nor specific, especially in the evaluation of early stages of RA. MRI is a new method of assessment of RA joints that has shown promising results in the detection of bone destruction and joint soft tissue involvement. Studies comparing MRI with CR, arthroscopy and the histopathological findings suggest that MRI may be considered as a new reference method for assessment of RA joints. Thanks to the recent technical developments, US can visualize soft tissues and superficial bone surfaces with high spatial resolution. With its potential to facilitate the diagnosis of RA and improve the assessment of disease activity, it may soon become a method routinely used by rheumatologists.

US in this PhD study was found to be a reproducible method of assessment of the destructive and inflammatory changes in RA finger and toe joints. It was possible to grade these changes. Additionally, US, in comparison with MRI as a reference method, was shown to be a reliable method for assessment of bone destruction and signs of inflammation in the examined RA finger and toe joints. US was more sensitive than plain film radiography for assessment of bone destruction in the examined joints and equally specific. B-mode US was more sensitive than clinical examination for assessment of signs of inflammation with a slight loss of specificity. In a substudy of power Doppler US (PDUS) of metacarpophalangeal (MCP) joints of RA patients and healthy control persons, a very high agreement was found between PDUS and dynamic MRI, which in earlier studies had shown a close correlation with histopathological signs of synovitis. Administration of ultrasonographical contrast agent did not result in detection of more joints with flow in the synovium.

The present study indicates a high reliability of US in assessment of RA finger and toe joints and strongly encourages its further studies.

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