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Abstract
Objectives To assess the prevalence and severity of ultrasonographic abnormalities of the hand and wrist of asymptomatic patients with systemic lupus erythematosus (SLE) and compare these findings with those from patients with SLE with musculoskeletal signs or symptoms and healthy controls.
Methods We conducted a prospective cross-sectional study that evaluated bilaterally, with grey-scale and power Doppler (PD) ultrasound (US), the dorsal hand (2nd to 5th metacarpophalangeal and 2nd to 5th proximal interphalangeal joints) and wrist (radiocarpal, ulnocarpal and intercarpal joints) of 30 asymptomatic patients with SLE, 6 symptomatic patients with SLE and 10 controls. Synovial hypertrophy (SH) and intra-articular PD signal were scored using semiquantitative grading scales (0–3). Individual scores were graded as normal (SH≤1 and PD=0) or abnormal (SH≥2 or PD≥1). Global indexes for SH and PD were also calculated. US findings were correlated with clinical and laboratory data and disease activity indexes.
Results US detected SH (score ≥1) in 77% asymptomatic patients with SLE, mostly graded as minimal (score 1: 63%). 23% of the asymptomatic patients with SLE showed abnormal US PD findings (SH≥2 or PD≥1). SH was present in all symptomatic patients with SLE, mostly graded as moderate (grade 2: 67%), and with associated PD signal (83%). SH (score 1) was identified in 50% of controls, however, none presented abnormal US PD findings. SH index in the asymptomatic SLE group was higher than in the control group (2.0 (0–5) vs 0.5 (0–2), median (range), p=0.01) and lower than in the symptomatic SLE group (7.0 (4–23), median (range), p<0.001). No significant correlation was demonstrated between US PD findings and clinical or laboratory variables and disease activity indexes.
Conclusion A small subgroup of asymptomatic patients with SLE may present subclinical joint inflammation. Global US scores and PD signal may be important in disease evaluation and therapeutic monitoring.
- Systemic Lupus Erythematosus
- Synovitis
- Ultrasonography
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Footnotes
Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have made substantial contributions to the work to take public responsibility for the content. Each author agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication. Specific contributions made by each author: Category 1 – Conception and design of study: CAR, SP, LSV, MFMF: Acquisition of data: CAR, RMo, JFO, SP, LSV, MFMF: Analysis and/or interpretation of data: CAR, MFM-F. Category 2 – Drafting the manuscript: CAR MFMF – Revising the manuscript critically for important intellectual content: CAR, RM, JFO, SP, LSV, MFM-F. Category 3 – Approval of the version of the manuscript to be published: CAR, RM, JFO, SP, LSV, MFM-F.
Competing interests None declared.
Patient consent Obtained.
Ethics approval All procedures performed were in accordance with the ethical standards of the Institutional Ethics Committee ((Comissão de Ética do Centro Hospitalar de Lisboa Central; approval number 1115 (2014)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.