SLR - March 2015 - Elizabeth Wakefield

Bone Erosions in Rheumatoid Arthritis: Ultrasound Findings in the Early Stage of the Disease

Reference:  Tamas MM, Filippucci E, Becciolini A, Gutierrez M, Di Geso L, Bonfiglioli K, Voulgari PV, Salaffi F, Grassi W. Bone Erosions in Rheumatoid Arthritis: Ultrasound Findings in the Early Stage of the Disease. Rheumatology. 2014 Jun; 53(6): 1100-1107.

Scientific Literature Review

Reviewed By: Elizabeth Wakefield, DPM
Residency Program: Grant Medical Center

Podiatric Relevance: Rheumatoid arthritis with erosive joint damage is devastating for patients, especially when the lower extremity is involved. Detection of erosions has been shown to indicate disease progression, and if treated aggressively and appropriately, can limit joint destruction, pain, and deformity. Podiatrists often suspect a diagnosis of rheumatoid arthritis when a patient presents with foot pain and deformity, however do not have joint erosions on radiographs.  Additionally, ultrasound is a quick and non-invasive technique many podiatrists have available in the office setting.

Methods: One-hundred sixty-five patients were recruited with diagnosed joint disease: 30 patients with early rheumatoid arthritis <12 months of disease duration, 80 patients with long-standing rheumatoid arthritis, 55 patients with psoriatic arthritis, osteoarthritis, or gout (disease control group), and 20 healthy controls without history of joint pathology.  An ultrasound was performed by a single rheumatologic sonographer of bilateral 2nd and 5th metacarpals, bilateral 1st and 5th metatarsals, and bilateral distal ulna. Erosions were classified on size, involved bone, topography, and extent with the joint divided into quadrants. Statistical analysis was performed with chi-square and student t-tests.

Results: Single erosions were found in 67 percent of patients with early rheumatoid arthritis and in 89 percent of patients with long-standing rheumatoid arthritis. The fifth metatarsal head was the most frequently involved site in early rheumatoid arthritis patients, with the lateral quadrant most often affected.  Long-standing rheumatoid arthritis patients most frequently had 2nd metacarpal head erosions. The 1st metatarsal head was most frequently associated with the osteoarthritis, psoriatic arthritis, and the gout control group. Early and long-standing rheumatoid arthritis patients had unifocal erosions at studied joints, where as the disease control group frequently had multifocal erosions.

Conclusions: This study determined that the 5th metatarsal head is the most common joint for new erosive changes in recently diagnosed patients with rheumatoid arthritis. Ultrasound is useful for screening or erosions in patients with suspected or recently diagnosed rheumatoid arthritis, prompting earlier treatment and preventing further joint destruction.  Early detection prevents further progression of erosive rheumatoid arthritis and better patient outcomes. 

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