Need for Greater Attention to Joint Damage in Rhupus Patients: Results from an Ultrasound Study

Abstract

BACKGROUND The aim of this study was to evaluate the prevalence of inflammation and bone destruction of hand joints in rhupus patients through ultrasound examination. MATERIAL AND METHODS Ten rhupus patients and 33 systemic lupus erythematosus (SLE) patients with hand arthropathy were recruited in this single-center study, and the clinical features and ultrasound manifestations of these patients were analyzed. RESULTS We discovered that rhupus patients were older (47.31±4.35 years vs. 38.58±2.50 years, P=0.040), had longer duration of disease (median 72 months vs. median 12 months, P=0.040), had a higher positive rate (70% vs. 10.71%, P<0.001), and had higher titers of anti-CCP antibody (42.633±14.520 vs. 2.121±0.970, P<0.001) than SLE patients with arthropathy. More importantly, the prevalence rates of synovial hyperplasia (90% vs. 42.42%, P=0.008), synovitis (90% vs. 18.18%, P<0.001), synovial hyperplasia (70% vs. 10.71%, P<0.001), and bone destruction (70% vs. 6.06%, P<0.001) were higher in rhupus patients than in SLE patients with arthropathy. CONCLUSIONS Rhupus patients are more prone to develop synovitis, synovial hyperplasia, and bone destruction. Therefore, more attention should be paid to protection of the joints in rhupus patients.

Figure 1

Enrollment of rhupus patients.

Figure 2

Enrollment of SLE patients with arthropathy.

Figure 3

Proportion of patients in the 2 groups who received steroids, MTX, HCQ, LEF, THH, bDMARDS, MMF, CsA, and CTX.

Figure 4

The number of affected hand joints in the 2 groups assessed by ultrasound testing, showing that rhupus patients had more affected joints (including PIP, MCP, and wrist) than SLE patients. (A) Synovial hyperplasia. (B) Synovitis. (C) Bone erosion.