Ultrasonography and detection of subclinical joints and tendons involvements in Systemic Lupus erythematosus (SLE) patients: A cross-sectional multicenter study - 04/04/18

Doi : 10.1016/j.jbspin.2018.01.013

Carine Salliot ^a,^⁎ , Amélie Denis ^b, Emmanuelle Dernis ^b, Vincent Andre ^b, Aleth Perdriger ^c, Jean-David Albert ^c, Saloua Mammou Mraghni ^d, Isabelle Griffoul-Espitalier ^d, Mohamed Hamidou ^e, Benoit Le Goff ^f, Sandrine Jousse Joulin ^g, Thierry Marhadour ^g, Christophe Richez ^h, Nicolas Poursac ^h, Estebaliz Lazaro ⁱ, Stéphanie Rist ^a, Anca Corondan ^a, Clara Quinten ^a, Virginie Martaillé ^a, Antoine Valéry ^j, Emilie Ducourau ^a
^a Rheumatology Unit, centre hospitalier regional d’Orleans, 14, avenue de l’Hôpital, CS 86709, 45067 Orleans cedex 2, France
^b Rheumatology, centre hospitalier du Mans, 72037 Le Mans, France
^c Rheumatology, hôpital Sud, 35033 Rennes, France
^d Rheumatology, CHRU de Tours, 37000 Tours, France
^e Internal medicine, GFEV, 44093 Nantes, France
^f Rheumatology, CHU Hôtel-Dieu, 44093 Nantes, France
^g Rheumatology, CHU la-Cavale-Blanche, 29200 Brest, France
^h Rheumatology, CHU Pellegrin, 33000 Bordeaux, France
ⁱ Internal medicine, CHU de Bordeaux, 33000 Bordeaux , France
^j DIM, Centre hospitalier regional d’Orleans, 45067 Orleans cedex 2, France

^⁎Corresponding author.

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Abstract

Objectives

The aims of this study in SLE population were (1) to describe ultrasonography (US) joint abnormalities, (2) to estimate the reliability of clinical swollen joint count (C-SJC) and SLEDAI (C-SLEDAI) versus US-SJC and US-SLEDAI scores, (3) to highlight specific patterns of lupus patients with Power Doppler (PD) abnormalities.

Method

For this cross-sectional multicenter study, 151 consecutive adult SLE patients were recruited. Evaluation included a clinical standardized joint assessment, B-mode and PD US of 40 joints and 26 tendons blinded for clinical examination. Reliability and agreement between clinical and B-mode US were calculated using the intraclass correlation coefficients (ICC [95% Confidence Interval]).

Results

We found a very high frequency of subclinical US abnormalities in asymptomatic patients: 85% of patients without joint symptoms had at least 1 US abnormality. Among them 46 patients (87%) had a history of joint involvement. The most frequent abnormalities were joint effusmaions (108 patients), synovial hypertrophy (SH, 109 patients) and synovitis (61 patients). Joint or tendon PD signal (grade>1) was found in 44% of patients (67/151). Synovitis were mainly located especially on MCPs and wrists. Even if reliability between clinical and grey-scale US SJC assessments was poor, reliability between clinical and US SLEDAI was good. Comparison between SLE patients with and without PD signal did not show any specific SLE pattern.