Ultrasound Hand and Wrist Findings in Children with Systemic Lupus Erythematosus

Abstract

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can involve any organ system. SLE often involves the musculoskeletal system to varying degrees and it is frequently joints of the hands that are most likely to give discomfort to patients. Objectives: To assess by ultrasound the presence of joint inflammation in patients with juvenile Systemic Lupus Erythematosus (JSLE) not complaining of painful joints of the hand and wrist (asymptomatic), and to compare the findings with those in JSLE patients complaining of painful hand and wrist joints (symptomatic) and in healthy controls. Methods: This was a cross-sectional case control study on 37 JSLE patients. Thirty were asymptomatic for joint complaint. Ultrasound examination of wrists and joints of both hands, 11 joints in each hand, to assess synovial hypertrophy, effusion and pathological vascularization [using power Doppler] (PD), and were given a score of 0-3. Patients were compared with 8 healthy controls. Results: Ultrasound abnormalities (synovial hypertrophy and increased vascularity) were detected in 22/30 of the asymptomatic patients (73.3%) and in all 7 symptomatic patients (100%). In asymptomatic children, 29 joints were affected (4.4% of all joints), compared to 13 joints in the symptomatic patients (8.4% of all joints). Synovitis score was mild or moderate (1 or 2) in both symptomatic and asymptomatic patients, with all showing increased vascularity. In the control group, 5 joints (2.8% of all joints) showed synovial hypertrophy but no increased vascularity. Conclusion: Increased vascularity (PD more than 0) is a more reliable indicator of inflammation than synovial hypertrophy which may be detected in healthy individuals.