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Ultrasound Finding of Subclinical Joint and Tendon Inflammation of the Patients with Systemic Lupus Erythematosus

Rifat Medjedovic1,3*, Milan Bogojevic1, Marina Ratkovic1,3, Radovan Milenkovic2, Milica Basaric2, Goran Radunovic2,4

Objective: Identify the frequency of subclinical inflammation with SLE (Systemic Lupus Erythematosus) patients, by ultrasound examination of joints, and tendons of elbows, wrists, hands, knees, ankles, and feet.

Methods: Joints and tendon ultrasound was done on 61 SLE patients, asymptomatic and symptomatic, by 2 ultrasonographers (of the mentioned joint and tendon regions), and magnetic resonance of a dominant hand (wrist and MCP (Metacarpophalangeal) joints) on 20 patients (from overall 61) by a radiologist, who didn’t do the ultrasound. A correlation was made between ultrasound findings with the clinical and laboratory parameters of disease activity, and with previous therapy approach.

Results: For wrists, 32% of asymptomatic patients and 39% of patients without objective synovitis had a US (Ultrasound) effusion/synovial hypertrophy, with a PD (Power Doppler) signal of 5% and 4.9%. For extensor tendons of the wrist, 30.8% asymptomatic and 40.7% without objective tenosynovitis had effusion/PD signal. For knees, 37.5% asymptomatic and 39.7% without objective synovitis had effusion/synovial hypertrophy, with PD signal there were 8.3% and 12.1%. When it comes to MTP3 and MTP4, 44.6% asymptomatic and 43.1% without objective synovitis had effusion/synovial hypertrophy, with PD signal there were 5.4% and 5.2%. Neither the comparison of parameters of disease activity (SLEDAI 2K, C3, C4, anti-dsDNA At, SE, CRP) nor the consideration of previous therapy approach prove a statistically significant difference of those with clinical and subclinical inflammation.

Conclusion: The greatest frequency of subclinical inflammation was identified in the wrist region (joints, extensor tendons), knees, and some small joints of the feet.