Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatism. The increasing use of bone and joint ultrasound as a tool to aid in the detection of unrefined synovitis in developed countries, has led us to study the performance of ultrasound in the diagnosis of RA in subjects consulting in rheumatology at Cotonou. Study Method: Descriptive cross-sectional study of patients with RA, selected on the basis of ACR/ EULAR 2010 criteria. A complete clinical examination with imaging including X-rays and ultrasounds of the hands and feet were performed in all patients who have given their consent. The data collected was analyzed using EPI data 3.1 and SPSS 24.0 software. The significance rate was defined with a p-value < 5%. Cohen’s Kappa (k) test was used to assess agreement. Results: All 53 patients included had lesions on ultrasound. Synovitis was found in 98.1% and bone erosions in 88.7%. There was no agreement in the wrists between clinical examination and ultrasound (k = -0.116), MCP (k = -0.097) and MTP (k = -0.031). Agreement was very low at the PPI level (k = 0.03). It was low at the different sites, between ultrasound and radiographic detection of lesions (k between 0.022 - 0.22). Age, positive immunologic RA factor and biological inflammatory syndrome were associated with ultrasound erosions (p = 0.0001) and only age was associated with active synovitis (p = 0.022). Conclusion: Bone and articular ultrasound is a good complementary alternative to clinical examination and radiography diagnostic in early diagnosis of RA in our developing countries, in the absence of MRI which remains a luxury.
References
[1]
Scott, D., Wolfe, F. and Huizinga, T. (2010) Rheumatoid Arthritis. Lancet, 376, 1094-1108. https://doi.org/10.1016/S0140-6736(10)60826-4
[2]
Van der Woude, D. and van der Helm-van Mil, A.H.M. (2018) Update on the Epidemiology, Risk Factors, and Disease Outcomes of Rheumatoid Arthritis. Best Practice & Research Clinical Rheumatology, 32, 174-187.
https://doi.org/10.1016/j.berh.2018.10.005
[3]
Avimadjè, M., Gounongbé, M. and Zomalhetho, Z. (2009) La polyarthrite rhumatoide au centre national hospitalo-universitaire de Cotonou. Benin Méd, 57, 55-57.
[4]
Zomalhèto, Z., Biaou, O., Yèkpè-Ahouansou, P., Gounongbé, M. and Avimadjè, M. (2015) Polyarthrite rhumatoïde en milieu hospitalier à Cotonou. Journal Africain d’Imagerie Médicale, 7, 39-46.
[5]
Pham, T. (2010) Comment intégrer l’imagerie moderne dans le diagnostic précoce et le suivi de la polyarthrite rhumatoïde? Journal de Radiologie, 91, 120-125.
https://doi.org/10.1016/S0221-0363(10)70017-2
[6]
Østergaard, M. and Wiell, C. (2004) Ultrasonography in Rheumatoid Arthritis: A Very Promising Method Still Needing More Validation. Current Opinion in Rheumatology, 16, 223-230. https://doi.org/10.1097/00002281-200405000-00010
[7]
Guerini, H., Ayral, X., Campagna, R., Feydy, A., Pluot, E., Rousseau, J., et al. (2010) Comment je fais un bilan échographique des mains et des pieds dans la polyarthrite rhumatoïde? Journal de Radiologie, 91, 99-110.
https://doi.org/10.1016/S0221-0363(10)70015-9
[8]
Bouty, N., Lardé, A., Demondion, X., Flipo, R.M. and Cotten, A. (2003) Polyarthrite rhumatoide débutante: Apport de l’échographie des articulations métacarpophalangiennes. Journal de radiologie, 84, 659-665.
[9]
Landis, J.R. and Koch, G.G. (1977) The Measurement of Observer Agreement for Categorical Data. Biometrics, 33, 159-174. https://doi.org/10.2307/2529310
[10]
do Prado, A.D., Staub, H.L., Bisi, M.C., da Silveira, I.G., Mendonça, J.A., Polido-Pereira, J., et al. (2018) Ultrasound and Its Clinical Use in Rheumatoid Arthritis: Where Do We Stand? Advances in Rheumatology, 58, Article No. 19.
https://doi.org/10.1186/s42358-018-0023-y
[11]
Naredo, E., Collado, P., Cruz, A., Palop, M.J., Cabero, F., Richi, P., et al. (2007) Longitudinal Power Doppler Ultrasonographic Assessment of Joint Inflammatory Activity in Early Rheumatoid Arthritis: Predictive Value in Disease Activity and Radiologic Progression. Arthritis Care & Research, 57, 116-124.
https://doi.org/10.1002/art.22461
[12]
Naredo, E., Valor, L., De la Torre, I., Martínez-Barrio, J., Hinojosa, M., Aramburu, F., et al. (2013) Ultrasound Joint Inflammation in Rheumatoid Arthritis in Clinical Remission: How Many and Which Joints Should Be Assessed? Arthritis Care & Research, 65, 512-517. https://doi.org/10.1002/acr.21869
[13]
Vreju, A.F., Chisalau, B.A., Parvanescu, C.D., Barbulescu, A., Rogoveanu, O., Firulescu, S., et al. (2016) High Frequency Ultrasonography of the Hand in Rheumatoid Arthritis, Psoriatic Arthritis, Gout and Osteoarthritis Patients. Current Health Sciences Journal, 42, 35-39. https://doi.org/10.12865/chsj.42.01.05
[14]
Harman, H., Tekeoğlu, I., Kaban, N. and Harman, S. (2015) Factors Influencing Ultrasonographic Remission in Patients with Rheumatoid Arthritis. Rheumatology International, 35, 485-491. https://doi.org/10.1007/s00296-014-3177-x
[15]
Peluso, G., Michelutti, A., Bosello, S., Gremese, E., Tolusso, B. and Ferraccioli, G. (2011) Clinical and Ultrasonographic Remission Determines Different Chances of Relapse in Early and Long Standing Rheumatoid Arthritis. Annals of the Rheumatic Diseases, 70, 172-175. https://doi.org/10.1136/ard.2010.129924
[16]
Kamishima, T., Tanimura, K., Henmi, M., Narita, A., Sakamoto, F., Terae, S., et al. (2009) Power Doppler Ultrasound of Rheumatoid Synovitis: Quantification of Vascular Signal and Analysis of Interobserver Variability. Skeletal Radiology, 38, 467-472.
https://doi.org/10.1007/s00256-009-0665-2
[17]
Tanaka, Y. (2016) Current Concepts in the Management of Rheumatoid Arthritis. The Korean Journal of Internal Medicine, 31, 210-218.
https://doi.org/10.3904/kjim.2015.137
[18]
Ben Abdelghani, K., Miladi, S., Souabni, L., Kassab, S., Chekili, S., Laatar, A., et al. (2015) Apport de l’échographie ostéoarticulaire au cours de la polyarthrite rhumatoïde en rémission. Journal de Radiologie Diagnostique et Interventionnelle, 96, S1-S10.
https://doi.org/10.1016/j.jradio.2014.05.012
[19]
Garrigues, F., Jousse-Joulin, S., Bouttier, R., Nonent, M., Bressollette, L. and Saraux, A. (2013) Concordance clinique et échographique dans la polyarthrite rhumatoïde. Revue du Rhumatisme, 80, 569-576. https://doi.org/10.1016/j.rhum.2013.05.005
[20]
Backhaus, M., Ohrndorf, S., Kellner, H., Strunk, J., Backhaus, T.M., Hartung, W., et al. (2009) Evaluation of a Novel 7-Joint Ultrasound Score in Daily Rheumatologic Practice: A Pilot Project. Arthritis Care & Research, 61, 1194-1201.
https://doi.org/10.1002/art.24646
[21]
Zufferey, P. and Becce, F. (2014) Rôle de l’imagerie dans le diagnostic et le suivi de la polyarthrite rhumatoïde. Revue Médicale Suisse, 421, 585-589.
[22]
Macchioni, P., Magnani, M., Mulè, R., Galletti, S., Catanoso, M., Pignotti, E., et al. (2013) Ultrasonographic Predictors for the Development of Joint Damage in Rheumatoid Arthritis Patients: A Single Joint Prospective Study. Clinical and Experimental Rheumatology, 31, 8-17.
[23]
Newman, J.S., Adler, R.S., Bude, R.O. and Rubin, J.M. (1994) Detection of Soft-Tissue Hyperemia: Value of Power Doppler Sonography. American Journal of Roentgenology, 163, 385-389. https://doi.org/10.2214/ajr.163.2.8037037
