ab225011

Wrist joint involvement in systemic lupus erythematosus. An ultrasonographic study

A. Iagnocco, A. Ossandon, G. Coari, F. Conti, R. Priori, C. Alessandri, G. Valesini

Rheumatology Unit, Department of Applied Clinical and Medical Therapy, University of Rome "La Sapienza", Italy

ABSTRACT
Objective
To define joint alterations in the wrists of patients with systemic lupus erythematosus (SLE) by ultrasonography (US).

Methods
Fifty-two wrists of 26 SLE patients and 30 wrists of 15 healthy controls were evaluated using US by two different experienced operators, blinded to the clinical data. A 14 MHz linear probe was used. Power Doppler (PD) was applied to evaluate the presence of synovial neoangiogenesis as a parameter of active local synovitis. The findings were correlated to the clinical evaluation, serological systemic disease activity parameters (ESR, C3 levels) and the SLE-disease activity score (SLEDAI). Statistical analysis was performed by the EPISTAT program.

Results
Signs of synovitis were found in 22 wrists (42.3%). Synovial proliferation was present in 10 joints (19.2%), PD positivity in 5 (9.6%) and joint effusion in 13 (25%). Erosions were present in both wrists (3.8%) of one patient. Signs of tenosynovitis of one or more tendons were shown in 23 cases (44.2%). Ganglia were found in 2 joints (3.8%). Changes of the median nerve, joint dislocations, tendonsÕ ruptures, cysts and nodules were never detected. In 14 wrists (26.9%) no alterations were found. There was no correlation between sonographic findings and clinical, laboratory and indexes signs of disease activity. In the control group the only alteration found was tenosynovitis in 1 joint (p < 0.0001).

Conclusion
US proved to be an useful technique to detect wrist joint alterations in SLE. These findings may help the physician to modulate treatment strategies and to perform a low cost monitoring of joint disease activity.

Key words
SLE, ultrasonography, power Doppler, wrist, tendons.

Please address correspondence and reprint requests to: Annamaria Iagnocco, MD, Cattedra Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata, Universitá di Roma "La Sapienza", V.le del Policlinico 155, Roma 00161, Italy.
E-mail address: annamaria.iagnocco@uniroma1.it