Authors: F Salaffi M Carotti P Manganelli E Filippucci G M Giuseppetti W Grassi
Publish Date: 2004/05/15
Volume: 23, Issue: 4, Pages: 285-290
Abstract
The aim of this study was to evaluate the ability of power Doppler sonography PDS with ultrasound contrast agent to assess the synovial perfusion changes induced by intraarticular steroid injection therapy in the knee joints of patients with rheumatoid arthritis RA Eighteen RA patients 16 women 2 men with a history and signs of active knee synovitis were studied Tenderness was evaluated using Thompson’s modified index of synovitis activity All patients underwent joint aspiration followed by intraarticular injection of 40 mg of triamcinolone hexacetonide Grayscale ultrasonography and PDS with an intravenous ultrasound contrast agent Levovist examinations were carried out before and 3 weeks after the intraarticular steroid injection The calculation of the time–intensity curves provided a quantitative estimation of the synovial perfusion The median values of the index of synovitis activity decreased significantly from 70 95 confidence interval CI 60–80 to 30 95 CI 20–40 p001 3 weeks after the intraarticular steroid injection All patients showed a reduction of PDS signal after intraarticular steroid therapy and the baseline and follow up median values of the area underlying time–intensity curves were 748 95 CI 579–873 and 245 95 CI 192–361 respectively The comparison between baseline and followup median values of the area under the curves showed a statistically significant reduction of PDS findings p001 At followup examinations the changes in the index score of the synovitis activity were significantly correlated to the changes in the values of the area underlying time–intensity curves r=0785 p001 A significant correlation was also observed between baseline values of the area underlying time–intensity curves and Creactive protein CRP r=0548 p=0023 In conclusion PDS with an intravenous ultrasound contrast agent has been shown to be able to detect changes in synovial perfusion after intraarticular steroid injection and may be an additional useful method in the evaluation of synovial inflammation and in the assessment of the therapeutic response
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