Assessment of both articular synovitis and tenosynovitis by ultrasound is useful for evaluations of hand dysfunction in early rheumatoid arthritis patients

Objectives: We investigated the association between hand dysfunction and ultrasound (US)-detected articular synovitis and tenosynovitis in patients with rheumatoid arthritis (RA). Methods: Thirty RA patients were examined. In both hands of all subjects, articular synovitis and tenosynovitis were assessed by US at 22 joints and 12 tendons. Each joint and tendon was scored by gray-scale (GS) and power Doppler (PD) on a scale from 0 to 3. The sums of the GS or PD scores were used as the articular synovitis score and the tenosynovitis score. The sum of the articular synovitis and tenosynovitis scores was used as the combined US score. Hand dysfunction was evaluated by a grip-Health Assessment Questionnaire (HAQ) and visual analog scale of morning stiffness (MS-VAS). We used Spearman's correlation coefficient to determine the relationships among the US scores, the two hand dysfunction indices, and the DAS28-ESR. Results: The articular synovitis scores were significantly correlated with grip-HAQ (GS: r(s)=0.47, p=0.009, PD: r(s)=0.48, p=0.006), but not with MS-VAS. The tenosynovitis scores were correlated with MS-VAS (GS: r(s)=0.38, p=0.039, PD: r(s)=0.36, p=0.053), but not with grip-HAQ. Both grip-HAQ (GS: r(s)=0.53, p=0.002, PD: r(s)=0.55, p=0.001) and the MS-VAS (GS: r(s)=0.39, p=0.031, PD: r(s)=0.47, p=0.008) were correlated with the combined US scores. Conclusions: The US scores combined with articular synovitis and tenosynovitis scores well reflect the severity of hand dysfunction in early-stage RA patients.