The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography
- PMID: 11145034
- DOI: 10.1002/1529-0131(200012)43:12<2762::AID-ANR16>3.0.CO;2-#
The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography
Abstract
Objective: The ability to make an early, accurate diagnosis of rheumatoid arthritis (RA) has become increasingly important with the availability of new, expensive, and targeted therapies. However, plain radiography, the traditional method of detecting the characteristic bone erosions and an important adjunct in establishing a diagnosis of RA, is known to be insensitive. This study compared sonography, a modern imaging technique, with conventional radiography for the detection of erosions in the metacarpophalangeal (MCP) joints of patients with RA.
Methods: One hundred RA patients (including 40 with early disease) underwent posteroanterior radiography and sonography of the MCP joints of the dominant hand. Twenty asymptomatic control subjects also underwent sonography. Erosion sites were recorded and subsequently compared using each modality. Magnetic resonance imaging (MRI) was performed on the second MCP joint in 25 patients with early RA to confirm the pathologic specificity of sonographic erosions. Intraobserver reliability of sonography readings was assessed using video recordings of 55 MCP joint scans of RA patients, and interobserver reliability was assessed by comparing 160 MCP joint scans performed sequentially by 2 independent observers.
Results: Sonography detected 127 definite erosions in 56 of 100 RA patients, compared with radiographic detection of 32 erosions (26 [81%] of which coincided with sonographic erosions) in 17 of 100 patients (P < 0.0001). In early disease, sonography detected 6.5-fold more erosions than did radiography, in 7.5-fold the number of patients. In late disease, these differences were 3.4-fold and 2.7-fold, respectively. On MRI, all sonographic erosions not visible on radiography (n = 12) corresponded by site to MRI abnormalities. The Cohen-kappa values for intra- and interobserver reliability of sonography were 0.75 and 0.76, respectively.
Conclusion: Sonography is a reliable technique that detects more erosions than radiography, especially in early RA. Sonographic erosions not seen on radiography corresponded to MRI bone abnormalities. This technology has potential in the management of patients with early RA/inflammatory arthritis and is likely to have major implications for the future practice of rheumatology.
Comment in
-
High-resolution ultrasound for the study of target joints in rheumatoid arthritis.Arthritis Rheum. 2002 Jul;46(7):1969-70; author reply 1970-1. doi: 10.1002/art.10310. Arthritis Rheum. 2002. PMID: 12124884 No abstract available.
-
Can very high-dose anti-tumor necrosis factor blockade at onset of rheumatoid arthritis produce long-term remission?Arthritis Rheum. 2002 Jul;46(7):1971-2; author reply 1973. doi: 10.1002/art.10274. Arthritis Rheum. 2002. PMID: 12124886 No abstract available.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous