PARIS – Inflammatory ultrasound features in hand osteoarthritis may point clinicians toward patients at higher risk for radiographic progression, a longitudinal study suggests.
"We found inflammatory ultrasound features are independently associated with both progressive joint space narrowing and progression of osteophytes in hand osteoarthritis. This is especially true with persistent inflammation," Dr. Marion Kortekaas said at the World Congress on Osteoarthritis.
Dr. Marion Kortekaas
She presented data on 56 consecutive hand OA patients who underwent baseline and 2.3-year follow-up radiographic and ultrasound assessment of all first carpometacarpal, distal interphalangeal, proximal interphalangeal, metacarpophalangeal, and first interphalangeal joints.
Radiographs were scored for osteophytes and joint space narrowing using the OARSI Atlas grading system (0-3 scale). Ultrasound synovial thickening, effusion, and power Doppler signal (PDS) were scored on a validated 3-point scale, with 3 being severe. Progression was defined as at least one grade increase of either joint space narrowing or osteophytes, explained Dr. Kortekaas, a rheumatologist at Leiden (the Netherlands) University Medical Center.
Most patients were female (86%) and their average age was 61 years. Patients with rheumatic diseases, trauma/operation, and corticosteroid use were excluded.
Of 1,680 joints at baseline, 141 (8.4%) had synovial thickening, 332 (19.8%) effusion, and 146 (8.7%) PDS.
At follow-up, progression of osteophytes and joint space narrowing was present in 120 and 96 joints, respectively, she said.
PDS, synovial thickening, and effusion were "persistent," defined as present at baseline and follow-up, in 40, 118, and 232 joints, and were "fluctuating," or present only at baseline or follow-up, in 243, 641, and 636 joints, respectively.
Using generalized estimating equations analyses, progression was independently associated with ultrasound synovial thickening (odds ratio, 2.6), effusion (OR, 3.5), and power Doppler signal (OR, 5.7) for grade 2-3 vs. grade 0, after adjustment for age, sex, body mass index, baseline osteophytes, and joint space narrowing scores, Dr. Kortekaas said.
Joint space narrowing was also independently associated with the ultrasound features of synovial thickening (OR, 3.4), effusion (OR, 3.3), and power Doppler signal (OR, 3.1), again after adjustment and comparing grade 2-3 vs. grade 0.
Persistent inflammation showed stronger associations with radiographic progression than did fluctuating inflammatory features in comparison with no inflammatory features at all, she said at the meeting, sponsored by the Osteoarthritis Research Society International.
During a discussion of the results, Dr. Kortekaas said inflammatory and synovial changes are loosely related to symptoms and pain, but that the group has yet to look at an association with C-reactive protein or inflammation in other joints.
Session comoderator Dr. Gillian Hawker, professor of medicine at the University of Toronto and physician in chief of medicine at Women’s College Hospital, Toronto, commented that until recently, ultrasound for hand OA has been far more common in clinical practice in Europe than in North America.
"I think that’s exactly where the radiology community is starting to go," she said in an interview. "Would we be doing a better job, picking things up earlier if we were ultrasounding? [There’s] definitely higher sensitivity. But, we haven’t quite gotten there yet. It’s going to cost money to get ultrasound machines into practices and train physicians."
Dr. Hawker observed that the American College of Radiology has added an ultrasound course and that residents at her institution are now going through ultrasound training as part of their residency.
Dr. Kortekaas and her coauthors reported no conflicting interests.