High resolution ultrasonography in assessment of rheumatoid knee synovitis: correlation with clinical and laboratory parameters

ABSTRACT

The formation of synovial pannus is an early event in the course of rheumatoid arthritis [RA] and could be seen before destruction of the cartilage and bone. Thus, its evaluation is of great benefit in the treatment and follow-up of clinical remission. The aim of this study was to investigate the presence of synovial pannus in the knee of RA patients with high-resolution ultrasonography and correlate the finding with the clinical and laboratory parameters of the disease. Thirty patients suffering from RA diagnosed according to the American College of Rheumatology [ACR] criteria together with 10 apparently healthy volunteers were included in the study. Both patients and controls were subjected to proper history taking and clinical examination including disease activity scoring [Mallya and Mace 1981] and functional assessment [Steinbrocker criteria, 1949] together with high resolution ultrasonography of the knee. Soluble adhesion molecules [SICAM-1 and E selectin] in the serum as well as serum and synovial L1F were also done. A high statistical significant difference was found in all laboratory and clinical findings between the patients group and control group including SIC AM-1, SE-selectin, serum and synovial LIF. Serum and synovial LIF correlated significantly with activity scoring [r- 0.8] and, functional status [r= 0.7]. However, SICAM-1 and SE-selectin correlated with activity scoring only [r= 0.48, r= 0.49 respectively]. Ultrasonographic findings were detected in the majority of the patients with statistically significant difference if compared with the control group. Synovial thickening correlated significantly with disease duration [r- 0.49], functional status [r- 0.58] and synovial LIF [r- 0.59]. Effusion showed a significant correlation with activity scoring [r= 0.5], SICAM-1 [r= 0.42] and synovial LIF [r= 0.59] while cartilage destruction correlated with disease duration [r= 0.51] and serum and synovial LIF [r= 0.53 and 0.65 respectively]. Soluble adhesion molecules may be an additional marker for disease activity while LIF may be an indicator of the severity of the disease. HRUS can evaluate the pannus formation in a trial to assess disease activity and the degree of severity to aid in therapeutic intervention and follow-up for clinical remission