Sternoclavicular Joint Involvement in Rheumatoid Arthritis: Clinical and Ultrasound Findings of a Neglected Joint

Authors

  • Pedro Rodríguez-Henríquez,

    1. Hospital General “Dr. Manuel Gea González,” Col. Sección XVI, Tlalpan, México, DF, Mexico
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  • Carla Solano,

    1. Hospital Nacional Rosales and Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
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  • Angélica Peña,

    1. Instituto Nacional de Rehabilitación, Col. Arenal de Guadalupe, Tlalpan, México, DF, Mexico
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  • Saúl León-Hernández,

    1. Instituto Nacional de Rehabilitación, Col. Arenal de Guadalupe, Tlalpan, México, DF, Mexico
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  • Cristina Hernández-Díaz,

    1. Instituto Nacional de Rehabilitación, Col. Arenal de Guadalupe, Tlalpan, México, DF, Mexico
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  • Marwin Gutiérrez,

    1. Università Politecnica delle Marche, Ancona, Italy
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    • Dr. Gutiérrez has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Abbott Laboratories, UCB Pharma, Bristol-Myers Squibb, and Esaote.

  • Carlos Pineda

    Corresponding author
    1. Instituto Nacional de Rehabilitación, Col. Arenal de Guadalupe, Tlalpan, México, DF, Mexico
    • Hospital General “Dr. Manuel Gea González,” Col. Sección XVI, Tlalpan, México, DF, Mexico
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Calzada Mexico-Xochimilco No. 289, Col. Arenal de Guadalupe, Tlalpan, 14389 México, DF, Mexico. E-mail: carpineda@yahoo.com

Abstract

Objective

To describe the prevalence of sternoclavicular (SC) joint involvement and the relationship between clinical and ultrasound (US) findings in patients with rheumatoid arthritis (RA).

Methods

One hundred three consecutive patients with RA and 103 age- and sex-matched healthy individuals were enrolled. Clinical evaluation and blinded US examinations of the SC joint were performed bilaterally in both groups. The presence of gray-scale synovitis, osteophytes, erosions, and intraarticular power Doppler (PD) was recorded. Interobserver agreement was calculated.

Results

A total of 412 SC joints were evaluated: 206 from patients with RA and 206 from healthy controls. In the RA group, 39 joints (19%) were found to be clinically involved (pain/swelling), in contrast to only 4 (1.9%) in the control group (P = 0.0001). In the RA group, US abnormalities were recorded in 89 SC joints (43%) compared with 36 (17%) in the healthy control group (P = 0.0001), comprising osteophytes in 59 (29%) versus 25 (12%; P = 0.0001), synovitis in 31 (15%) versus 5 (2%; P = 0.0001), erosions in 23 (11%) versus none (P = 0.0001), and intraarticular PD in 5 (2%) versus none (P = 0.03). Furthermore, a correlation between the presence of US synovitis (P < 0.001) and intraarticular PD (P < 0.0001) with a higher Disease Activity Score in 28 joints (DAS28) was found.

Conclusion

In patients with RA, US detected a higher number of involved SC joints than with clinical assessment. Our results indicate that both gray-scale and PD US findings were more prevalent in patients with RA than in healthy controls. US synovitis and synovial hyperperfusion correlated with the DAS28, suggesting that SC joints actively participate in the systemic inflammatory process of RA.

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