Clinical and Ultrasound Concordance of Joint Damages in Rheumatoid Arthritis in a Resource-Limited Country

Abstract

Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatism. The increasing use of bone and joint ultrasound as a tool to aid in the detection of unrefined synovitis in developed countries, has led us to study the performance of ultrasound in the diagnosis of RA in subjects consulting in rheumatology at Cotonou. Study Method: Descriptive cross-sectional study of patients with RA, selected on the basis of ACR/ EULAR 2010 criteria. A complete clinical examination with imaging including X-rays and ultrasounds of the hands and feet were performed in all patients who have given their consent. The data collected was analyzed using EPI data 3.1 and SPSS 24.0 software. The significance rate was defined with a p-value < 5%. Cohen’s Kappa (k) test was used to assess agreement. Results: All 53 patients included had lesions on ultrasound. Synovitis was found in 98.1% and bone erosions in 88.7%. There was no agreement in the wrists between clinical examination and ultrasound (k = −0.116), MCP (k = −0.097) and MTP (k = −0.031). Agreement was very low at the PPI level (k = 0.03). It was low at the different sites, between ultrasound and radiographic detection of lesions (k between 0.022 - 0.22). Age, positive immunologic RA factor and biological inflammatory syndrome were associated with ultrasound erosions (p = 0.0001) and only age was associated with active synovitis (p = 0.022). Conclusion: Bone and articular ultrasound is a good complementary alternative to clinical examination and radiography diagnostic in early diagnosis of RA in our developing countries, in the absence of MRI which remains a luxury