SAT0540 CLINICAL AND ULTRASONOGRAPHIC ASSESSMENT OF STERNOCLAVICULAR JOINT IN PATIENTS WITH RA
Authors: Hassan Bassiouni, Khaled Zaky, Hany Eitta, Ibraheem Elsakka
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The sternoclavicular (SC) joint is a real diarthrodial joint that can be affected during the route of RA; but, its scientific implications appear to remain underestimated through the rheumatology network, (1) ultrasound (US) is right extensively common imaging approach in each clinical exercise and in rheumatology studies to visualize joints and tender tissues. To date, there is a regular frame of evidence assisting its validity, reliability, and feasibility inside the evaluation of persistent inflammatory arthritis and its higher sensitivity than scientific exam in the analysis of synovitis, enthesitis, and tenosynovitis in these patients (2). <h3>Objectives</h3> To describe the prevalence of sternoclavicular (SC) joint involvement and the relationship between clinical and ultrasound (US) findings in patients with rheumatoid arthritis. <h3>Methods</h3> 120 subjects with age range from 20 to 50 years were recruited from Physical Medicine, Rheumatology and Rehabilitation department of Sayed Galal and Al-Hussein Al-Azhar University Hospitals, during the period from April 2018 to October 2018. All the patients were informed about the study and signed an informed consent. S<b>ubjects were divided into two groups:</b> Group A: 60 patient known as RA fulfilling ACR criteria for classification of rheumatoid arthritis (1987) (3). Group B: 60 normal control subjects. All subjects have been clinically evaluated and t blinded US examinations of the SC joint were performed bilaterally in both groups. The presence of gray-scale synovitis, erosions, and intraarticular power Doppler (PD) was recorded. <h3>Results</h3> A total of 240 SC joints were evaluated: 120 from patients with RA and 120 from healthy controls. In the RA group, 21 joints (17.5%) were found to be clinically involved (pain/swelling), in contrast to only 6 (5%) in the control group (P = 0.002). In the RA group, US abnormalities were recorded in 62 SC joints (51%) compared with 3 (2.5%) in the healthy control group (P = 0.0001), comprising synovitis in 28 (23.3%) versus 3 (2.5%);(P &lt;0.001), erosions in 27 (22.5%) versus none (P &lt;0.001), and intraarticular PD in 7 (5.8%) versus none (P = 0.031). Furthermore, a correlation between the presence of US synovitis (P &lt; 0.001) and intraarticular PD (P &lt; 0.0001) with a higher Disease Activity Score in 28 joints (DAS28) was found. <h3>Conclusion</h3> US is extra sensitive than medical examination for detecting SC joint involvement in RA. The correlation amongst US synovitis, intraarticular PD, and the DAS28 show that SC joints actively participate within the systemic inflammatory manner of RA. The precise position of US within the assessment of the SC joint in sufferers with RA is but to be mounted firmly in the rheumatologic examination. <h3>References</h3> [1] - Rodríguez-Henríquez, P., Solano, C., Peña, A., León-Hernández, S., et al. (2013). Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint. Arthritis care &amp; research, 65(7), 1177-1182. [2] - Filippucci, E., Annamaria, I., Meenagh, G., Riente, L., Delle Sedie, A., Bombardieri, S.,. .. &amp; Grassi, W. (2006). Ultrasound imaging for the rheumatologist II. Ultrasonography of the hand and wrist. Clinical and experimental rheumatology, 24(2), 118-122. [3] -– Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum1988;31:315–24. <h3>Acknowledgement</h3> Prof. Dr. Sameh Elzayyat <h3>Disclosure of Interests</h3> None declared