Follow up of activity in rheumatoid arthritis by gray scale US and power Doppler US for 12 months

Document Type : Original Article


1 Department of Rheumatology and Rehabilitation, Sohag Faculty of Medicine, Sohag University

2 Department of Internal Medicine and Department of Rheumatology, Rehabilitation and Physical medicine,Faculty of Medicine- Sohag University.

3 Department of Rheumatology, Rehabilitation and Physical medicine - Faculty of Medicine- Sohag University.


Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by the development of synovitis, which damages cartilage, bone, ligaments, and tendons. US is available, noninvasive, and relatively inexpensive bedside imaging method with high patient acceptability. This technique is more sensitive and reproducible than clinical evaluation in assessing joint inflammation. Power Doppler (PD) US detect flow from small vessels and low velocity flow at the microvascular level. PD US detects indirect signs of increased vascularization associated with soft tissue musculoskeletal inflammatory and infectious diseases and enteritis in spondyloarthropathies.
Aim of the work: Follow up of RA patients for assessment activity by gray scale and PD during 12 months.
Patients and Methods: longitudinal observational study included 30 Adult patients fulfilling 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism criteria will be included in this study.
Results: There was high significant difference between different times of follow up (start, 6, 12 months) as regards count of swollen joints, tender joints, VAS, and DAS (p value <0.001) as mean value of them decreased significantly from start up to 12 months. There was high significant difference between different times of follow up (start, 6, 12 months) as regards RT US gray scale count, LT US gray scale count, Total US gray scale count, and Total US gray scale number  (p value <0.001) as mean value of them decreased significantly from start up to 12 months
Conclusion: The combination of grey scale US and PD could be used as a sensitive and reliable non-invasive and widely available method complementary to standard clinical assessment for evaluating rheumatoid synovial inflammation in daily management and clinical trials.


1.  Aletaha D, Smolen J, Ward MM. Measuring function in rheumatoid arthritis: Identifying reversible and irreversible components. Arthritis and rheumatism. 2006;54(9):2784-92.
2.  Pap T, Distler O. Linking angiogenesis to bone destruction in arthritis. Arthritis and rheumatism. 2005;52(5):1346-8.
3.  Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Annals of the rheumatic diseases. 2005;64(3):375-81.
4.  Karim Z, Wakefield RJ, Quinn M, Conaghan PG, Brown AK, Veale DJ, et al. Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis and rheumatism. 2004;50(2):387-94.
5.  D'Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis and rheumatism. 2003;48(2):523-33.
6.  Garrigues F, Jousse-Joulin S, Bouttier R, Nonent M, Bressollette L, Saraux A. Concordance between clinical and ultrasound findings in rheumatoid arthritis. Joint, bone, spine : revue du rhumatisme. 2013;80(6):597-603.
7.  Terslev L, Torp-Pedersen S, Qvistgaard E, Bliddal H. Spectral Doppler and resistive index. A promising tool in ultrasonographic evaluation of inflammation in rheumatoid arthritis. Acta radiologica. 2003;44(6):645-52.
8.  Dougados M, Jousse-Joulin S, Mistretta F, d'Agostino MA, Backhaus M, Bentin J, et al. Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: results from a prospective multicentre study of rheumatoid arthritis. Annals of the rheumatic diseases. 2010;69(5):828-33.
9.  Scire CA, Montecucco C, Codullo V, Epis O, Todoerti M, Caporali R. Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology. 2009;48(9):1092-7.
10.       Peluso G, Michelutti A, Bosello S, Gremese E, Tolusso B, Ferraccioli G. Clinical and ultrasonographic remission determines different chances of relapse in early and long standing rheumatoid arthritis. Annals of the rheumatic diseases. 2011;70(1):172-5.
11.       Saleem B, Brown AK, Quinn M, Karim Z, Hensor EM, Conaghan P, et al. Can flare be predicted in DMARD treated RA patients in remission, and is it important? A cohort study. Annals of the rheumatic diseases. 2012;71(8):1316-21.