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Rheumatoid arthritis (RA) is an inflammatory disorder characterized by poly-articular inflammation and pannus formation, results in joint destruction and severe disability.
SMI seems more sensitive than PDI for
detecting hand joint lesions in RA in clinical remission PDI, and could aid the
achievement of true remission in RA patients.
Rheumatoid arthritis (RA) is an inflammatory disorder
characterized by poly-articular inflammation and pannus formation, results in
joint destruction and severe disability. The primary goal for the treatment of
RA is the remission or low disease activity. The number of remission criteria
has been established in the past few years such as clinical and biological
criteria. However, several studies have shown infra-clinical synovitis, and
disease has persisted in patients who achieved clinical remission. Thus, it is
essential to identify the actual reduction in RA patients.
Imaging techniques, such as magnetic resonance imaging
(MRI), have been suggested to detect persistent inflammation in RA patients;
however, they require contrast enhancement. Also, power Doppler imaging (PDI)
can detect modifications in synovial vascularity, but it is not very sensitive
to micro-vascular patterns and low blood flow velocity. Another is the superb
micro-vascular imaging (SMI), which is a new innovative and effective
ultrasound (US) Doppler modality, which can visualize low-velocity flow in
micro-vessels. Moreover, SMI can detect synovial inflammation in rheumatic
diseases. However, to date, the utility of SMI for evaluating hand joint
lesions in patients with RA in clinical remission has not been reported.
Rationale behind research:
The utility of SMI for evaluating
hand joint lesions in patients with RA in clinical remission has not been
reported till date.
Therefore, the present study was
conducted to investigate SMI signals in the hand joint of patients with RA and to
demonstrate the value of SMI for identifying true remission in RA.
Objective:
To investigate SMI signals in the
hand joint of patients with RA in clinical remission and compare the findings
with those of PDI.
Study outcomes:
Time period: NA
RA is characterized by erosive synovitis which causes
irreversible bone damage and loss of function. Thus, remission is important for
RA patients. In the current study, it was shown that SMI was more sensitive
than PDI for detecting synovial vessel signals of the hand joint in RA patients
who achieved clinical remission. This study also suggested that SMI has
excellent potential for improving diagnostic accuracy in evaluating RA
remission.
The results of the current research showed that SMI
recognised more synovial blood flow signal than PDI in the 572 hand joints. The
moderate inter-observer agreement between PDI and SMI indicates that SMI is a
feasible and reliable technique. In recent years, SMI has been reported to
allow the visualization of low-velocity flow in micro-vessels excluding the use
of contrast agents, high costs, and invasiveness. Moreover, several studies
have indicated that SMI significantly improved the detection of blood flow
signal and synovial inflammation within the joints in RA patients. The present
study is the first to evaluate SMI in RA patients with clinical remission.
Compared with PDI, SMI significantly improved the detection of synovial blood
flow signals.
In conclusion, It was revealed that SMI is more sensitive
than PDI for the detection of hand joint synovitis in RA patients who have
achieved clinical remission. Further studies are needed to validate the role of
SMI in improving diagnostic accuracy in RA remission.
The results of the Present study demonstrated that SMI is more sensitive
than PDI for the detection of hand joint synovitis in RA patients who have
achieved clinical remission.
Rheumatol Int (2018)
Superb microvascular imaging (SMI) for evaluating hand joint lesions in patients with rheumatoid arthritis in clinical remission
Xiaolong Yu et al.
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