Comparative Study of Radiological Changes in Hands and Feet in Patients Suffering from Early Rheumatoid Arthritis by Power Doppler Ultrasound and Direct Digital Radiography

Abstract

Rheumatoid arthritis is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis. The natural history of disease is such that the early months of the disease are critical period during which reversible joint damage occurs. So early diagnosis of RA and appropriate drug ap-plication is the only way to save a patient from this crippling disease. In India, the cost of investigations is a sig-nificant factor for most of the patients. Ultrasonography or Power Doppler Ultra Sound (PDUS) has the advan-tage of being economic in spite of its sensitivity in assessing both inflammatory and destructive changes. The aim of the present study was to evaluate the diagnostic efficiency of PDUS in early rheumatoid arthritis. The study was performed with the patients attending Rheumatology Clinic. A total number of 106 patients of clinically suspected rheumatoid arthritis were studied as per selection criteria. Radiological examinations of hands were done by digital radiography and PDUS in a group of 53 patients, assessment of foot changes by PDUS and Digi-tal Radiography were done in another similar group of 53 patients. Final diagnosis by ACR EULAR-2010 crite-ria is done for all the patients. The comparative study reveals that synovial vascularity as demonstrated by PDUS is much more effective in diagnosing early rheumatoid arthritis, both in hand and in feet than digital ra-diograph. PDUS of feet may yield earlier and better findings than hands, which is conventionally used in patients suffering from early rheumatoid arthritis. KEYWORDS R.A.—Rheumatoid Arthritis; PDUS—Power Doppler Ultrasound; D.R.—Digital Radiography; ACR-EULAR—American College of Rheumatology (ACR) and the European League against Rheumatism (EULAR); RF—Rheumatoid Factor; CRP—c-Reactive Protein; MRI—Magnetic Resonance Imaging