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Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound.

Freeston JE, Coates LC, Nam JL, Moverley AR, Hensor EM, Wakefield RJ, Emery P, Helliwell PS, Conaghan PG - Arthritis Care Res (Hoboken) (2014)

Bottom Line: In contrast, clinical overestimation of synovitis occurred most commonly at the shoulder (38%) and ankle (28.6%).This study has demonstrated that subclinical synovitis, as identified by US, is very common in early PsA and led to the majority of oligoarthritis patients being reclassified as having polyarthritis.Further research is required into the relationship of such subclinical synovitis to structural progression.

View Article: PubMed Central - PubMed

Affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.

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Related in: MedlinePlus

Graphical summary (homunculus) of A, subclinical synovitis (shown in red), graded according to the proportion of joints in which ultrasound (US) was positive (gray-scale [GS] score ≥2 or power Doppler [PD] score ≥1 present) and clinical examination (CE) was negative (no tenderness or swelling) and B, apparent clinical overestimation of synovitis (shown in red), graded according to the proportion of joints in which US was negative (GS score ≥2 or PD score ≥1 absent) and CE was positive (tenderness and/or swelling present). White = 0% of joints; red = 50% of joints.
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fig01: Graphical summary (homunculus) of A, subclinical synovitis (shown in red), graded according to the proportion of joints in which ultrasound (US) was positive (gray-scale [GS] score ≥2 or power Doppler [PD] score ≥1 present) and clinical examination (CE) was negative (no tenderness or swelling) and B, apparent clinical overestimation of synovitis (shown in red), graded according to the proportion of joints in which US was negative (GS score ≥2 or PD score ≥1 absent) and CE was positive (tenderness and/or swelling present). White = 0% of joints; red = 50% of joints.

Mentions: A total of 47 (96%) of 49 patients had ≥1 joint showing subclinical synovitis; in these patients, the median number of joints with subclinical synovitis was 4 (interquartile range [IQR] 2–7, range 1–19). Subclinical PD changes were identified in 17 (34.7%) of 49 patients; in these patients, the median number of joints with subclinical PD was 1 (IQR 1–2, range 1–4). Excluding MTP joints and ankles, 37 (75.5%) of 49 patients had subclinical synovitis (median 3 [IQR 1–4], range 1–11); 15 (30.6%) of 49 had subclinical PD changes (median 1 [IQR 1–2], range 1–4). The distribution of subclinical synovitis defined by the combination of GS and/or PD US signal in different joints assessed is shown in Figure 1A. Subclinical synovitis (defined as a GS score ≥2 and/or a PD score ≥1 in a joint, in the absence of tenderness or swelling) was seen in 12.4% (237 of 1,908) of the joints scanned (16.6% [237 of 1,431] of the clinically normal joints) and PD signal was present in 1.6% (30 of 1,908) of all joints scanned (2.1% [30 of 1,431] of the clinically inactive joints). Excluding MTP joints and ankles, subclinical synovitis was seen in 9.8% (130 of 1,320) of the joints scanned (13.5% [130 of 963] of clinically inactive joints), whereas subclinical PD was seen in 1.8% (24 of 1,320) of the joints scanned (2.5% [24 of 963] of clinically inactive joints). Subclinical synovitis was seen most frequently in the wrist (30.6% [30 of 98 joints]), knee (21.4% [21 of 98 joints]), MTP1 (26.5% [26 of 98 joints]), and MTP2 (33.7% [33 of 98 joints]). The MCP2 (16.3% [16 of 98 joints]), MCP5 (19.4% [19 of 98 joints]), and MTP3 (10.2% [10 of 98 joints]) also showed subclinical activity to a slightly lesser degree.


Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound.

Freeston JE, Coates LC, Nam JL, Moverley AR, Hensor EM, Wakefield RJ, Emery P, Helliwell PS, Conaghan PG - Arthritis Care Res (Hoboken) (2014)

Graphical summary (homunculus) of A, subclinical synovitis (shown in red), graded according to the proportion of joints in which ultrasound (US) was positive (gray-scale [GS] score ≥2 or power Doppler [PD] score ≥1 present) and clinical examination (CE) was negative (no tenderness or swelling) and B, apparent clinical overestimation of synovitis (shown in red), graded according to the proportion of joints in which US was negative (GS score ≥2 or PD score ≥1 absent) and CE was positive (tenderness and/or swelling present). White = 0% of joints; red = 50% of joints.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4282111&req=5

fig01: Graphical summary (homunculus) of A, subclinical synovitis (shown in red), graded according to the proportion of joints in which ultrasound (US) was positive (gray-scale [GS] score ≥2 or power Doppler [PD] score ≥1 present) and clinical examination (CE) was negative (no tenderness or swelling) and B, apparent clinical overestimation of synovitis (shown in red), graded according to the proportion of joints in which US was negative (GS score ≥2 or PD score ≥1 absent) and CE was positive (tenderness and/or swelling present). White = 0% of joints; red = 50% of joints.
Mentions: A total of 47 (96%) of 49 patients had ≥1 joint showing subclinical synovitis; in these patients, the median number of joints with subclinical synovitis was 4 (interquartile range [IQR] 2–7, range 1–19). Subclinical PD changes were identified in 17 (34.7%) of 49 patients; in these patients, the median number of joints with subclinical PD was 1 (IQR 1–2, range 1–4). Excluding MTP joints and ankles, 37 (75.5%) of 49 patients had subclinical synovitis (median 3 [IQR 1–4], range 1–11); 15 (30.6%) of 49 had subclinical PD changes (median 1 [IQR 1–2], range 1–4). The distribution of subclinical synovitis defined by the combination of GS and/or PD US signal in different joints assessed is shown in Figure 1A. Subclinical synovitis (defined as a GS score ≥2 and/or a PD score ≥1 in a joint, in the absence of tenderness or swelling) was seen in 12.4% (237 of 1,908) of the joints scanned (16.6% [237 of 1,431] of the clinically normal joints) and PD signal was present in 1.6% (30 of 1,908) of all joints scanned (2.1% [30 of 1,431] of the clinically inactive joints). Excluding MTP joints and ankles, subclinical synovitis was seen in 9.8% (130 of 1,320) of the joints scanned (13.5% [130 of 963] of clinically inactive joints), whereas subclinical PD was seen in 1.8% (24 of 1,320) of the joints scanned (2.5% [24 of 963] of clinically inactive joints). Subclinical synovitis was seen most frequently in the wrist (30.6% [30 of 98 joints]), knee (21.4% [21 of 98 joints]), MTP1 (26.5% [26 of 98 joints]), and MTP2 (33.7% [33 of 98 joints]). The MCP2 (16.3% [16 of 98 joints]), MCP5 (19.4% [19 of 98 joints]), and MTP3 (10.2% [10 of 98 joints]) also showed subclinical activity to a slightly lesser degree.

Bottom Line: In contrast, clinical overestimation of synovitis occurred most commonly at the shoulder (38%) and ankle (28.6%).This study has demonstrated that subclinical synovitis, as identified by US, is very common in early PsA and led to the majority of oligoarthritis patients being reclassified as having polyarthritis.Further research is required into the relationship of such subclinical synovitis to structural progression.

View Article: PubMed Central - PubMed

Affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.

Show MeSH
Related in: MedlinePlus