Ultrasonographic evaluation of Hand and Wrist joint involvement in Rheumatoid arthritis and its association with disease activity markers in a Tertiary Care Centre, Chennai

Abstract

Introduction: Rheumatoid Arthritis (RA) is a chronic autoimmune disease affecting hand and wrist joints and also causing symmetrical joint synovitis. Radiography is used to measure bone and cartilage loss, although physical examinations are usually used to assess synovial inflammation. Both MRI and ultrasound are more sensitive than radiography in identifying synovitis. Various modalities to characterise the activity of joint inflammation include laboratory test like RF, ANA titer, CRP level and ESR. Aim and Objectives: To assess the involvement of wrist and hand joints in RA using USG (which combines grayscale and PD imaging) and to associate the imaging findings with biomarkers of activity of disease (ESR, CRP and DAS scoring). Materials and Methods: This cross-sectional study was conducted in the Department of Radiology at a tertiary care hospital, in Chennai. A total of sixty individuals, of all age and both genders, with RA who underwent USG andwhose blood investigations shows increased inflammatory markers such as ESR and CRP were included in the study Results: Majority of cases belongs to age group 41 -50 years with female predominance. Mean ESR was 39.5 mm and mean CRP was 10.3 mg/dl. Mean RF titer was noted as 42.5 IU/ml, mean DAS score was 4.4 and mean CFS score was 4.9. On power Doppler findings, out of 600 MCP joints 12.2% of joints were abnormal, whereas out of 120 RC joints 55.8% of joints were abnormal. Out of 120 UC joints 42.5% of joints were abnormal. Mean CFS scores among the different DAS score and elevated CRP levels were noted as remarkably significant. Conclusion: USG is better imaging modality than conventional radiography for early diagnosis of RA. CFS is found to be a better alternative for CRP, ESR followed by USG, the second better option and X rays being the least preference of option.