Ultrasound and MRI in the diagnosis of RA patients with synovitis

Early identification and treatment of rheumatoid arthritis (RA) lead to reduced inflammation and reduced joint damage, resulting in better long-term results. According to the current guidelines for therapeutic targets, there is a reliable and repeatable diagnostic tool to find and monitor the treatment of RA is helpful.

 

Japanese researchers point out that recent advances have led to the rise of ultrasound and MRI patterns, making them the tool of choice for diagnosing and monitoring disease activity in RA patients. They point out that "The presence of inflammation observed with US or MRI can be used to predict progression from undifferentiated inflammatory arthritis to clinical RA.

 

The group tried to compare the accuracy of ultrasound and MRI in the diagnosis of RA  patients with synovitis. They systematically reviewed and meta-analyzed the available literature. The main result is the diagnostic accuracy of ultrasound on synovitis with MRI as the standard.

Finally, 14 studies were included in the final analysis. The wrist, metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) were evaluated separately.

The diagnostic radiosonde odds ratio (DOR) produced by the wrist cohort was 11.6 and the area under the curve (AUC) was 0.81, indicating that synovitis has good diagnostic test accuracy.

 

Sensitivity and specificity of wrist ultrasound were 0.73 and 0.78, respectively.

The MCP cohort produced an ultrasound DOR of 28 and an AUC of 0.91, which provided good diagnostic test accuracy for synovitis.

The sensitivity and specificity of MCP combined with ultrasound were 0.64 and 0.93, respectively.

The PIP cohort produced an ultrasound DOR of 23 and an AUC of 0.91 indicating a good diagnostic test for synovitis.

The sensitivity and specificity of PIP combined ultrasound were 0.71 and 0.94, respectively.

The knee joint group produced an ultrasound DOR of 5.3 and an AUC of 0.61, indicating a poor diagnostic test for synovitis.

The sensitivity and specificity of knee ultrasound did not reflect diagnostic value in the trial.

Inspiration

 

Ultrasound is a cheap, repeatable and accurate diagnostic tool for the diagnosis of synovitis in RA patients, especially when examining MCP and PIP joints. Ultrasound may not be the preferred method of diagnosis of synovitis in the knee. In outpatients, ultrasound is a good choice for the diagnosis of synovitis in RA patients. Power Doppler ultrasound shows better diagnostic test accuracy than grayscale ultrasound.

 

Ultrasound in the detection of synovitis is accurate, especially in the metacarpophalangeal joint and proximal interphalangeal joint.

Although more sensitive than clinical exams, ultrasound is less sensitive than MRI for deeper joints such as the wrist and knee.

There is a lack of consensus about the standard ultrasound scoring system for synovitis. Compared with MRI, ultrasound is cheaper, carry less, contraindications less.