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Benefits of ultrasonography in the management of early arthritis: a cross-sectional study of baseline data from the ESPOIR cohort
Rheumatology, 09/18/09

Funck-Brentano1 T et al. – US on six joints detected 1.4-fold more patients with erosions (3.3-fold more with the usual reading). In clinical practice, US combined with X-rays is of helpful diagnostic value in EA.

Methods

Four centres assessed the structural damage by both X-ray and US examination at baseline
X-rays of hands and feet were read first by the centre's local investigator (usual reading), then in the X-ray coordinating centre (central reading)
Four trained examiners performed US blindly from clinical data to detect erosions on the second and fifth MCP (MCP2 and 5) and the fifth MTP (MTP5) joints bilaterally

Results

Patients’ characteristics (n = 126) were: female 78%; mean age 50.3 years; disease duration 103 days; disease activity score on 28 joints 5; CRP level 22.7 mg/l; and 79.4% of the patients fulfilling RA ACR criteria
US revealed 42 (36.8%) patients with erosive disease, whereas radiography revealed only 30 (26%) with central reading and only 11% with usual reading
US missed erosive disease present in X-rays in 10 (8.8%) patients
Combined technique of both revealed 52 (45.6%) patients with erosive diseases
On the targeted joints, US detected erosion on 75 (11%) joints vs X-rays on only 11 (1.5%)
Only three joints with erosion(s) detected on X-rays were missed on US
At baseline, the presence of PD activity was not associated with joint erosions

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