Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2004 Apr;63(4):382–385. doi: 10.1136/ard.2003.007062

Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease

R Wakefield 1, M Green 1, H Marzo-Ortega 1, P Conaghan 1, W Gibbon 1, D McGonagle 1, S Proudman 1, P Emery 1
PMCID: PMC1754934  PMID: 15020331

Abstract

Objective: To determine the prevalence of subclinical synovitis using ultrasound (US) imaging of both painful and asymptomatic joints, in patients with early (<12 months), untreated oligoarthritis (⩽5 joints).

Methods: Eighty patients underwent a detailed clinical assessment by two physicians. All painful joints were identified, which were immediately scanned by a sonographer. In the last 40 patients, an additional standard group of joints was scanned to establish the prevalence of synovitis in asymptomatic joints.

Results: In 80 patients, 644 painful joints (with and without clinical synovitis) were identified and each underwent a US assessment. Of these joints, 185 had clinical synovitis, of which, US detected synovitis in only 79% (147/185). In the other 38 joints US demonstrated tenosynovitis instead of synovitis in 12 joints and possible, but not definite, synovitis in 11 joints. Fifteen joints were, however, normal on US. In 459 joints that were not clinically synovitic, US detected synovitis in 33% (150/459). In 64% (51/80) of patients, US detected synovitis in more joints than clinical examination and in 36% (29/80) of patients, US detected a polyarthritis (>6 joints). Of the 826 asymptomatic (non-painful) joints scanned, 13% (107/826) had US detected synovitis.

Conclusion: Sonography detected more synovitis than clinical examination in patients with oligoarthritis. In almost two thirds of patients there was evidence of subclinical disease while one third could be reclassified as polyarticular. These findings suggest that a definition of oligoarthritis based purely on clinical findings may be inappropriate, which may have important implications for disease management.

Full Text

The Full Text of this article is available as a PDF (247.0 KB).

Figure 1 .

Figure 1

Open in a new tab

Number of patients (n = 80) with swollen joints (n = 185) as detected by clinical examination.

Figure 2 .

Figure 2

Open in a new tab

Number of patients with US detected synovitis in different numbers of joints.

Figure 3 .

Figure 3

Open in a new tab

Prevalence of US detected synovitis in joints which were asymptomatic (n = 826), clinically painful but not swollen (n = 425), and clinically synovitic joints (n = 185).

Figure 4 .

Figure 4

Open in a new tab

(A) Longitudinal US image through a non-painful MTP joint demonstrating no evidence of synovitis. M, metacarpal head; P, base of proximal phalanx; *normal intra-articular fat pad. (B) Longitudinal US image through a painful but not clinically synovitic MTP joint demonstrating synovitis (S) and loss of definition of normal intra-articular fat pad. M, metacarpal head; P, base of proximal phalanx.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alarcón Graciela S., Lopez-Ben Robert, Moreland Larry W. High-resolution ultrasound for the study of target joints in rheumatoid arthritis. Arthritis Rheum. 2002 Jul;46(7):1969–1971. doi: 10.1002/art.10310. [DOI] [PubMed] [Google Scholar]
  2. Backhaus M., Burmester G. R., Gerber T., Grassi W., Machold K. P., Swen W. A., Wakefield R. J., Manger B., Working Group for Musculoskeletal Ultrasound in the EULAR Standing Committee on International Clinical Studies including Therapeutic Trials Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis. 2001 Jul;60(7):641–649. doi: 10.1136/ard.60.7.641. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Balint P., Sturrock R. D. Musculoskeletal ultrasound imaging: a new diagnostic tool for the rheumatologist? Br J Rheumatol. 1997 Nov;36(11):1141–1142. doi: 10.1093/rheumatology/36.11.1141. [DOI] [PubMed] [Google Scholar]
  4. Canoso J. J. Ultrasound imaging: a rheumatologist's dream. J Rheumatol. 2000 Sep;27(9):2063–2064. [PubMed] [Google Scholar]
  5. Elliott M. J., Woo P., Charles P., Long-Fox A., Woody J. N., Maini R. N. Suppression of fever and the acute-phase response in a patient with juvenile chronic arthritis treated with monoclonal antibody to tumour necrosis factor-alpha (cA2). Br J Rheumatol. 1997 May;36(5):589–593. doi: 10.1093/rheumatology/36.5.589. [DOI] [PubMed] [Google Scholar]
  6. Grassi W., Cervini C. Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis. 1998 May;57(5):268–271. doi: 10.1136/ard.57.5.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Grassi W., Filippucci E., Farina A., Salaffi F., Cervini C. Ultrasonography in the evaluation of bone erosions. Ann Rheum Dis. 2001 Feb;60(2):98–103. doi: 10.1136/ard.60.2.98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Green M., Marzo-Ortega H., Wakefield R. J., Astin P., Proudman S., Conaghan P. G., Hordon L., Emery P. Predictors of outcome in patients with oligoarthritis: results of a protocol of intraarticular corticosteroids to all clinically active joints. Arthritis Rheum. 2001 May;44(5):1177–1183. doi: 10.1002/1529-0131(200105)44:5<1177::AID-ANR201>3.0.CO;2-5. [DOI] [PubMed] [Google Scholar]
  9. Jacobson J. A., Andresen R., Jaovisidha S., De Maeseneer M., Foldes K., Trudell D. R., Resnick D. Detection of ankle effusions: comparison study in cadavers using radiography, sonography, and MR imaging. AJR Am J Roentgenol. 1998 May;170(5):1231–1238. doi: 10.2214/ajr.170.5.9574591. [DOI] [PubMed] [Google Scholar]
  10. Koski J. M. Ultrasonography of the metatarsophalangeal and talocrural joints. Clin Exp Rheumatol. 1990 Jul-Aug;8(4):347–351. [PubMed] [Google Scholar]
  11. Kraan M. C., Versendaal H., Jonker M., Bresnihan B., Post W. J., t Hart B. A., Breedveld F. C., Tak P. P. Asymptomatic synovitis precedes clinically manifest arthritis. Arthritis Rheum. 1998 Aug;41(8):1481–1488. doi: 10.1002/1529-0131(199808)41:8<1481::AID-ART19>3.0.CO;2-O. [DOI] [PubMed] [Google Scholar]
  12. Kvien T. K., Glennås A., Melby K. Prediction of diagnosis in acute and subacute oligoarthritis of unknown origin. Br J Rheumatol. 1996 Apr;35(4):359–363. doi: 10.1093/rheumatology/35.4.359. [DOI] [PubMed] [Google Scholar]
  13. Manger B., Kalden J. R. Joint and connective tissue ultrasonography--a rheumatologic bedside procedure? A German experience. Arthritis Rheum. 1995 Jun;38(6):736–742. doi: 10.1002/art.1780380603. [DOI] [PubMed] [Google Scholar]
  14. Pando J. A., Duray P., Yarboro C., Gourley M. F., Klippel J. H., Schumacher H. R. Synovitis occurs in some clinically normal and asymptomatic joints in patients with early arthritis. J Rheumatol. 2000 Aug;27(8):1848–1854. [PubMed] [Google Scholar]
  15. Parker J. D., Capell H. A. An acute arthritis clinic--one year's experience. Br J Rheumatol. 1986 Aug;25(3):293–295. doi: 10.1093/rheumatology/25.3.293. [DOI] [PubMed] [Google Scholar]
  16. Schmidt W. A., Völker L., Zacher J., Schläfke M., Ruhnke M., Gromnica-Ihle E. Colour Doppler ultrasonography to detect pannus in knee joint synovitis. Clin Exp Rheumatol. 2000 Jul-Aug;18(4):439–444. [PubMed] [Google Scholar]
  17. Soden M., Rooney M., Cullen A., Whelan A., Feighery C., Bresnihan B. Immunohistological features in the synovium obtained from clinically uninvolved knee joints of patients with rheumatoid arthritis. Br J Rheumatol. 1989 Aug;28(4):287–292. doi: 10.1093/rheumatology/28.4.287. [DOI] [PubMed] [Google Scholar]
  18. Wakefield R. J., Gibbon W. W., Conaghan P. G., O'Connor P., McGonagle D., Pease C., Green M. J., Veale D. J., Isaacs J. D., Emery P. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 2000 Dec;43(12):2762–2770. doi: 10.1002/1529-0131(200012)43:12<2762::AID-ANR16>3.0.CO;2-#. [DOI] [PubMed] [Google Scholar]
  19. Wakefield R. J., Gibbon W. W., Emery P. The current status of ultrasonography in rheumatology. Rheumatology (Oxford) 1999 Mar;38(3):195–198. doi: 10.1093/rheumatology/38.3.195. [DOI] [PubMed] [Google Scholar]
  20. Wolfe F., Ross K., Hawley D. J., Roberts F. K., Cathey M. A. The prognosis of rheumatoid arthritis and undifferentiated polyarthritis syndrome in the clinic: a study of 1141 patients. J Rheumatol. 1993 Dec;20(12):2005–2009. [PubMed] [Google Scholar]
  21. van Holsbeeck M., van Holsbeeck K., Gevers G., Marchal G., van Steen A., Favril A., Gielen J., Dequeker J., Baert A. Staging and follow-up of rheumatoid arthritis of the knee. Comparison of sonography, thermography, and clinical assessment. J Ultrasound Med. 1988 Oct;7(10):561–566. doi: 10.7863/jum.1988.7.10.561. [DOI] [PubMed] [Google Scholar]
  22. van der Heijde D. M. Joint erosions and patients with early rheumatoid arthritis. Br J Rheumatol. 1995 Nov;34 (Suppl 2):74–78. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES