Wrist joint involvement in systemic lupus erythematosus. An ultrasonographic study

Clin Exp Rheumatol. Sep-Oct 2004;22(5):621-4.

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, tendons' 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.

MeSH terms

  • Adult
  • Cohort Studies
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / diagnostic imaging*
  • Male
  • Middle Aged
  • Neovascularization, Pathologic / diagnostic imaging
  • Tenosynovitis / diagnostic imaging*
  • Tenosynovitis / etiology
  • Ultrasonography, Doppler / methods
  • Wrist Joint / blood supply
  • Wrist Joint / diagnostic imaging*