Skip to main content

Advertisement

SpringerLink
Log in

A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

The aim of this study is to characterize bone erosions in metatarsal heads (MTH) in rheumatoid arthritis (RA) and gout by grayscale ultrasound. In a descriptive, cross-sectional study, we evaluated 40 patients with RA and 40 with gout, both diagnosed according to the American College of Rheumatology/European League Against Rheumatism criteria, respectively. All patients had bone erosion demonstrated by ultrasound, which was used, following OMERACT criteria, to describe the shape, size, number, border definition, overhanging margin, topography (intra- or extra-articular), and distribution (over dorsal, medial, lateral, or plantar aspect) of the lesions in the MTH. Descriptive statistics were used and a concordance exercise between two ultrasonographers blinded to the diagnosis was performed. Bone erosions in RA were observed most frequently at the plantar and lateral aspect of the fifth MTH, round in 96 %, small-sized (2.43 ± 0.9 mm), intra-articular (100 %), and single (75 %). Few bone erosions had a well-defined border an overhanging margin while in gout were found most frequently in the medial and dorsal aspect of the first MTH, single in 71 %, intra-articular in 100 %, and of median size (4.0 ± 2.3). For shape, 51 % was round and 49 % was oval. A well-defined border was present in 39 %, and an overhanging margin in 62 %. Inter-rater reliability kappa was excellent (0.81, 95 % CI 0.56–1.00). Some characteristics of bone erosions in RA, including shape, size, ill-defined border, and localization in the fifth MTH could distinguish the lesions from gout. Grayscale US has excellent reliability to describe bone erosions in RA and gout.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Graphic 1
Graphic 2

Similar content being viewed by others

References

  1. Selmi C, Generali E, Massarotti M, Bianchi G, Sciré CA (2014) New treatments for inflammatory rheumatic disease. Immunol Res 60:277–288

    Article  CAS  PubMed  Google Scholar 

  2. Salaffi F, Gutierrez M, Carotti M (2014) Ultrasound versus conventional radiography in the assessment of bone erosions in rheumatoid arthritis. Clin Exp Rheumatol 32(Suppl 80):S85–S90

    PubMed  Google Scholar 

  3. Mottonen TT (1998) Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis. Ann Rheum Dis 47:648–653

    Article  Google Scholar 

  4. Szkudlarek M, Terslev L, Wakefield RJ, Backhaus M, Balint PV, Bruyn G et al (2016) Summary findings of a systematic literature review of the ultrasound assessment of bone erosions in rheumatoid arthritis. J Rheumatol 43:12–21

    Article  PubMed  Google Scholar 

  5. Backhaus M, Kamradt T, Sandrock D, Loreck D, Fritz J, Wolf KJ et al (1999) Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 42:1232–1245

    Article  CAS  PubMed  Google Scholar 

  6. Wakefield RJ, Gibbon WW, Conaghan PG, O’Connor P, McGonagle D, Pease C et al (2000) The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 43:2762–2770

    Article  CAS  PubMed  Google Scholar 

  7. Zayat AS, Ellegard K, Conaghan PG, Terslev l, Hensor EMA, Freeston JE et al (2014) The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis 0:1–7

    Google Scholar 

  8. Rome K, Frecklington M, McNeir P, Gow P, Dalbeth N (2012) Foot pain, impairment and disability in patients in acute gout flares: a prospective observational study. Arthritis Care Res 64:384–388

    Article  Google Scholar 

  9. Buckley TJ (1996) Radiologic features of gout. Am Fam Physician 54:1232–1238

    CAS  PubMed  Google Scholar 

  10. Thiele RG, Schlesinger N (2007) Diagnosis of gout by ultrasound. Rheumatology 46:1116–1121

    Article  CAS  PubMed  Google Scholar 

  11. Grassi W, Filippucci E, Farina A, Salaffi F, Cervini C (2001) Ultrasonography in the evaluation of bone erosions. Ann Rheum Dis 60:98–103

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Töpfer D, Gerner B, Finzel S, Kraus S, Museyko O, Schett G et al (2015) Automated three-dimensional registration of high-resolution peripheral quantitative computed tomography data to quantify size and shape changes of arthritic bone erosions. Rheumatology 54:2171–2180

    PubMed  Google Scholar 

  13. Schett G (2009) Osteoimmunology in rheumatic diseases. Arthritis Res Ther 11:210

    Article  PubMed  PubMed Central  Google Scholar 

  14. Schlesinger N, Thiele R (2010) The pathogenesis of bone erosions in gouty arthritis. Ann Rheum Dis 69:1907–1912

    Article  CAS  PubMed  Google Scholar 

  15. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588

    Article  PubMed  Google Scholar 

  16. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher R, Berendsen D et al (2015) 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 74:1789–1798

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA et al (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–649

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Wakefield R, Balint P, Skudlarek M, Filippuci E, Backhaus M, D’Agostino MA et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487

    PubMed  Google Scholar 

  19. Gutiérrez M, Schmidt WA, Thiele RG, Keen HI, Kaeley GS, Naredo E et al (2015) international consensus for ultrasound lesions in gout: results of delphi process and web-reliability exercise. Rheumatology 54:1797–1805

    Article  PubMed  Google Scholar 

  20. Naredo E, DaGostino MA, Wakefield RJ, Möller I, Balint PV, Filippucci E et al (2013) Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 72:1328–1334

    Article  PubMed  Google Scholar 

  21. Peiteado D, de Miguel E, Villalba A, Ordoñez MC, Castillo C, Martín Mola E (2012) Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clin Exp Rheumatol 30:830–837

    PubMed  Google Scholar 

  22. Landis JR, Koch GG (1997) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  Google Scholar 

  23. López-Ben RK, Bernreuter W, Moreland LW, Alarcón GS (2004) Ultrasound detection of bone erosions in rheumatoid arthritis: a comparison to routine radiographs of the hands and feet. Skelet Radiol 33:80–84

    Article  Google Scholar 

  24. Weidekamm C, Koller M, Weber M, Kainberger F (2003) Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 48:325–333

    Article  CAS  PubMed  Google Scholar 

  25. Dohn UM, Terslev L, Szkudlarek M, Hansen MS, Hetland ML, Hansen A et al (2013) Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT. Ann Rheum Dis 72:530–534

    Article  PubMed  Google Scholar 

  26. Baillet A, Gaujoux-Viala C, Mouterde G, Pham T, Tebib J, Saraux A et al (2011) Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatology 50:1137–1147

    Article  PubMed  Google Scholar 

  27. Resnick D, Niwayama G. Rheumatoid arthritis. In: Resnick D, Editor. Diagnosis of Bone and Joint Disorders. 3rd ed. Philadelphia., PA, USA: W.B. Saunders; 1995. pp. 866–970

  28. van der Leeden M, Steultjens MP, Ursum J, Dahmen R, Roorda LD, Schaardenburg DV et al (2008) Prevalence and course of forefoot impairments and walking disability in the first eight years of rheumatoid arthritis. Arthritis Rheum 59:1596–1602

    Article  PubMed  Google Scholar 

  29. Klocke R, Glew D, Cox N, Blake DR (2001) Sonographic erosions of the rheumatoid little toe. Ann Rheum Dis 60:896–897

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Filippucci E, Meenagh G, Delle Sedie A, Sakellariou G, Iagnocco A, Riente L et al (2011) Ultrasound imaging for the rheumatologist XXXVI. Sonographic assessment of the foot in gout patients. Clin Exp Rheumatol 29:901–905

    PubMed  Google Scholar 

  31. Villaverde V, Rosario MP, Loza E, Pérez F (2014) Systematic review of the value of ultrasound and magnetic resonance musculoskeletal imaging in the evaluation of response to treatment of gout. Reumatol Clin 10:160–163

    Article  PubMed  Google Scholar 

  32. Tamas MM, Filippucci E, Becciolini A, Gutiérrez M, Di Geso L, Bonfiglioli K et al (2014) Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease. Rheumatology 53:1100–1107

    Article  PubMed  Google Scholar 

  33. Siddle HJ, Hensor EMA, Hodgson RJ, Grainger AJ, Redmond AC, Wakefield RJ et al (2014) Anatomical location of erosions at the metatarsophalangeal joints in patients with rheumatoid arthritis. Rheumatology 53:932–936

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Siddle HJ, Hodgson RJ, O’Connor P, Grainger AJ, Redmond AC, Wakefield RJ et al (2012) Magnetic resonance arthrography of lesser metatarsophalangeal joints in patients with rheumatoid arthritis: relationship to clinical, biomechanical, and radiographic variables. J Rheumatol 39:1786–1791

    Article  PubMed  Google Scholar 

  35. Siddle HJ, Hodgson RJ, Redmond AC, Grainger AJ, Wakefield RJ, Pickles DA et al (2012) MRI identifies plantar plate pathology in the forefoot of patients with rheumatoid arthritis. Clin Rheumatol 31:621–629

    Article  PubMed  Google Scholar 

  36. Riente L, Delle Siede A, Sciré CA, Filippucci E, Meenagh G, Iagnocco A et al (2011) XXXI. Sonographic assessment of the foot in patients with rheumatoid arthritis. Clin Exp Rheumatol 29:1–5

    PubMed  Google Scholar 

  37. Wright SA, Filippucci E, McVeigh C, Grey A, McCarron M, Grassi W et al (2007) High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis 66:859–864

    Article  PubMed  Google Scholar 

  38. Hulsmann HM, Jacobs JV, van der Heijde DM, van Albada-Kuipers GA, Schenk Y, Bijlsma JW (2000) The course of radiologic damage during the first six years of rheumatoid arthritis. Arthritis Rheum 43:1927–1940

    Article  Google Scholar 

  39. Bloch C, Hermann G, Yu TF (1980) A radiologic reevaluation of gout: a study of 2000 patients. AJR Am J Roentgenol 134:781–787

    Article  CAS  PubMed  Google Scholar 

  40. Jansen LMA, van der Horst-Bruinsma IE, van Schaardenburg D, Bezemer PD, Dijkmans BA (2001) Predictors of radiographic joint damage in patients with early rheumatoid arthritis. Ann Rheum Dis 60:924–927

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Martel W (1968) The overhanging margin of bone: a Roentgenologic manifestation of gout. Radiology 91:755–756

    Article  CAS  PubMed  Google Scholar 

  42. Gentili A (2006) The advanced imaging of gouty tophi. Curr Rheumatol Rep 8:231–235

    Article  PubMed  Google Scholar 

  43. McNally EG (2008) Ultrasound of the small joints of the hands and feet: current status. Skelet Radiol 37:99–113

    Article  CAS  Google Scholar 

  44. Thiele RG (2011) Ultrasound in the diagnosis of crystals deposition diseases In: Robert Terkeltaub (ed) Gout & Other Crystal Arthropathies, 1st edn. USA, Saunders Elsevier, pp 331–343

  45. Rettenbacher T, Ennemoser S, Weirich H, Ulmer H, Hartig F, Klotzet W et al (2008) Diagnostic imaging of gout. Comparison of high-resolution US versus conventional X-ray. Eur Radiol 18:621–630, 2008

    Article  PubMed  Google Scholar 

  46. Thiele RG, Schlesinger N (2009) Ultrasonography shows active inflammation in clinically unaffected joints in chronic tophaceous gout. Arthritis Rheum 59(9 Suppl):S1512

    Google Scholar 

  47. Stewart S, Dalbeth N, Vandal AC, Rome K (2016) The first metatarsophalangeal joint in gout: a systematic review and meta-analysis. BMC Musculoskelet Disord 17:69. doi:10.1186/s12891-016-0919-9

    Article  PubMed  PubMed Central  Google Scholar 

  48. Naredo E, Uson J, Jiménez-Paplop M, Martínez A, Vicente E, Brito E et al (2014) Ultrasound-detected musculoskeletal urate cristal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis 73:1522–1528

    Article  PubMed  Google Scholar 

  49. Peluso G, Bosello SL, Gremesel E, Mironel L, Di Gregorio F, Di Molfetta V et al (2015) Detection of bone erosions in early rheumatoid arthritis: 3D ultrasonography versus computed tomography. Clin Rheumatol 34:1181–1186

    Article  CAS  PubMed  Google Scholar 

  50. Finzel S, Ohrndorf S, Englbrecht M, Stach C, Masserschmidt J, Schett G et al (2011) A detailed comparative study of high-resolution ultrasound and micro–computed tomography for detection of arthritic bone erosions. Arthritis Rheum 63:1231–1236

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México

    Lucio Ventura-Ríos & Cristina Hernández-Díaz

  2. Servicio de Cirugía de Columna. Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México

    Guadalupe Sanchez-Bringas

  3. Laboratorio de Medicina de Conservación. Escuela Superior de Medicina. Instituto Politécnico Nacional, México City, México

    Eduardo Madrigal-Santillán & José Antonio Morales-González

  4. Dirección de Investigación, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México

    Carlos Pineda

Authors
  1. Lucio Ventura-Ríos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Hernández-Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guadalupe Sanchez-Bringas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eduardo Madrigal-Santillán
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. José Antonio Morales-González
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlos Pineda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucio Ventura-Ríos.

Ethics declarations

Disclosures

None.

Funding

No source of support in the form of grants neither industrial support.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ventura-Ríos, L., Hernández-Díaz, C., Sanchez-Bringas, G. et al. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol 35, 2269–2276 (2016). https://doi.org/10.1007/s10067-016-3338-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-016-3338-2

Keywords

Search

Navigation