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Contrast-enhanced power Doppler sonography of knee synovitis in rheumatoid arthritis: assessment of therapeutic response

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Abstract

The aim of this study was to evaluate the ability of power Doppler sonography (PDS) with ultrasound contrast agent to assess the synovial perfusion changes induced by intra-articular steroid injection therapy in the knee joints of patients with rheumatoid arthritis (RA). Eighteen RA patients (16 women, 2 men) with a history and signs of active knee synovitis were studied. Tenderness was evaluated using Thompson’s modified index of synovitis activity. All patients underwent joint aspiration followed by intra-articular injection of 40 mg of triamcinolone hexacetonide. Gray-scale ultrasonography and PDS with an intravenous ultrasound contrast agent (Levovist) examinations were carried out before and 3 weeks after the intra-articular steroid injection. The calculation of the time–intensity curves provided a quantitative estimation of the synovial perfusion. The median values of the index of synovitis activity decreased significantly from 7.0 (95% confidence interval (CI) 6.0–8.0) to 3.0 (95% CI 2.0–4.0) (p<0.01) 3 weeks after the intra-articular steroid injection. All patients showed a reduction of PDS signal after intra-articular steroid therapy and the baseline and follow up median values of the area underlying time–intensity curves were 7.48 (95% CI 5.79–8.73) and 2.45 (95% CI 1.92–3.61), respectively. The comparison between baseline and follow-up median values of the area under the curves showed a statistically significant reduction of PDS findings (p<0.01). At follow-up examinations the changes in the index score of the synovitis activity were significantly correlated to the changes in the values of the area underlying time–intensity curves (r=0.785; p<0.01). A significant correlation was also observed between baseline values of the area underlying time–intensity curves and C-reactive protein (CRP) (r=0.548; p=0.023). In conclusion, PDS with an intravenous ultrasound contrast agent has been shown to be able to detect changes in synovial perfusion after intra-articular steroid injection and may be an additional useful method in the evaluation of synovial inflammation and in the assessment of the therapeutic response.

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Abbreviations

DMARD:

Disease-modifying anti-rheumatic drugs

NSAID:

Non-steroidal anti-inflammatory drugs

PDS:

Power Doppler sonography

RA:

Rheumatoid arthritis

RF:

Rheumatoid factor

US:

Ultrasonography

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Authors and Affiliations

  1. Department of Rheumatology, Ospedale ‘A. Murri’, Università Politecnica delle Marche, Via dei Colli 52, 60035, Jesi, Ancona, Italy

    F. Salaffi, E. Filippucci & W. Grassi

  2. Department of Radiology, Università Politecnica delle Marche, Ancona, Italy

    M. Carotti & G. M. Giuseppetti

  3. Rheumatic Disease Unit (RDU), Hospital of Parma, Parma, Italy

    P. Manganelli

Authors
  1. F. Salaffi
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  2. M. Carotti
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  3. P. Manganelli
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  4. E. Filippucci
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  5. G. M. Giuseppetti
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  6. W. Grassi
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Correspondence to F. Salaffi.

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Salaffi, F., Carotti, M., Manganelli, P. et al. Contrast-enhanced power Doppler sonography of knee synovitis in rheumatoid arthritis: assessment of therapeutic response. Clin Rheumatol 23, 285–290 (2004). https://doi.org/10.1007/s10067-004-0878-7

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  • DOI: https://doi.org/10.1007/s10067-004-0878-7

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