Rheumatoid Arthritis: Koski JM

Koski JM, Hermunen H. · Mikkeli Central Hospital, Finland. · Scand J Rheumatol. · Pubmed #11727840 No free full text.

Abstract: Fifty consecutive patients with RA and clinical wrist synovitis were randomly allocated to either receive an injection of glucocorticoid into the radiocarpal joint or have the same amount of drug divided into the radiocarpal and midcarpal joints. Inferior radioulnar joint synovitis was treated with extra steroid injection only in the latter group. Patient's and doctor's assessments as well as ultrasonography improved significantly at month 3 in both groups. A statistical difference between the groups was found in the midcarpal joint measurement favouring the extra midcarpal injection. Ten wrists (20%) were normal when assessed with ultrasound at month 3 while 34 wrists (68%) were normal on clinical assessment.

Wakefield RJ, D'Agostino MA, Iagnocco A, Filippucci E, Backhaus M, Scheel AK, Joshua F, Naredo E, Schmidt WA, Grassi W, Moller I, Pineda C, Klauser A, Szkudlarek M, Terslev L, Balint P, Bruyn GA, Swen WA, Jousse-Joulin S, Kane D, Koski JM, O'Connor P, Milutinovic S, Conaghan PG, Anonymous00480. · Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK. · J Rheumatol. · Pubmed #17407236 No free full text.

Abstract: Ultrasound (US) is a relatively new imaging modality in rheumatology that offers great potential as a diagnostic and management tool. In 2004, an OMERACT Ultrasound Special Interest Group was formed to address the metric qualities of US as a potential outcome measure. A preliminary systematic review highlighted the deficiencies in the literature, particularly with regard to the reliability of interpreting and acquiring images; as a consequence, a number of exercises were proposed to address these issues. This report describes a series of iterative studies that have resulted in improved intra- and inter-reader reliability for detecting and scoring synovitis from both static and real-time images of the hand joints of patients with rheumatoid arthritis. The reliability of acquiring images was also enhanced using standardized positions. Future studies will assess the value of US in clinical trials.

Koski JM, Saarakkala SJ, Heikkinen JO, Hermunen HS. · Mikkeli Central Hospital, Mikkeli, Finland. · Clin Exp Rheumatol. · Pubmed #15971426 No free full text.

Abstract: OBJECTIVES: To investigate experimentally the echogenicity of air, a steroid suspension and physiological saline mixed with water in order to find the best contrast medium for injections. To show the practical applications of an airsteroid-saline mixture as a contrast medium in rheumatology. METHODS: In vitro. First, quality assurance measurements were conducted twice on the ultrasound (US) equipment. Subsequently air, a steroid suspension, or physiological saline mixed with water, first alone and then in different combinations, were examined with US using quantitative image analysis. Clinical. The effectiveness of an air-steroid-saline mixture as contrast medium in ultrasonography was tested in joint, bursa and tendon sheath injections. RESULTS: In vitro. Based on the quality assurance measurements the physical performance of the US equipment was excellent. Verified visually and quantitatively the mixture of air, steroid and saline produced the best contrast on US. The importance of air bubbles producing contrast was obvious. Clinical application. Firstly, visualisation of the contrast medium with US made it possible to follow in real-time the passage of a drug to the target area. Secondly, the use of the contrast method verified the presence of steroid in the synovial target intended after a blind injection. Thirdly, anatomical and pathologic anatomical connections could be visualized using this contrast medium in the wrist, shoulder, knee, ankle and foot joint CONCLUSIONS: Verification of US system performance by quality assurance measurement is essential for US imaging. The air-steroid-saline contrast medium method of ultrasound scanning is a somewhat invasive, but inexpensive and rapid method. It can verify the existence or non-existence of an air-steroid-saline contrast medium in the desired place and in adjacent structures, thus showing possible pathologic anatomic connections. The method has a diagnostic and therapeutic value, and expands the interventional spectrum of sonographic imaging.

Luukkainen R, Sanila MT, Saltyshev M, Huhtala H, Koski JM. · Department of Rheumatology, Rauma Regional Hospital, Steniuksenkatu 2, 26100, Rauma, Finland. · Clin Rheumatol. · Pubmed #15940556 No free full text.

Abstract: The aim of this study was to compare the relationship between clinically detected swelling and effusion diagnosed by ultrasonography (US) in elbow joints in patients with rheumatoid arthritis (RA). Fifty consecutive patients with RA entered the study and 20 healthy persons formed a control group. Altogether 100 elbow joints of the RA patients and 40 of the controls were studied. All the clinical assessments were performed by one doctor and the US investigations by the other and they were blinded to each others results. In 77 elbow joints of the RA patients the clinical assessment and the US gave similar results, whereas they differed in the remaining 23 joints. The kappa coefficient between these investigations was 0.371. In the control group no elbow joint showed either swelling in the clinical assessment or effusion in the US investigation. The results of this study indicate that clinical assessment of swelling and evaluation of effusion by US in elbow joints in patients with RA show only fair agreement. Thus, US may improve the accuracy of diagnosis of synovitis in many cases in these patients.

Luukkainen RK, Saltyshev M, Koski JM, Huhtala HS. · Department of Rheumatology, Satalinna Hospital, Harjavalta, Finland. · Clin Exp Rheumatol. · Pubmed #14611113 No free full text.

Abstract: OBJECTIVE: To assess the relationship between clinically detected swelling and effusion diagnosed by ultrasonography (US) in metatarsophalangeal (MTP) and talocrural (TC) joints in patients with rheumatoid arthritis (RA). METHODS: Thirty consecutive patients with RA were studied. Altogether 288 MTP joints and 60 TC joints were evaluated. The clinical investigations were carried out by one doctor and the US investigations by another and they were blinded to each others' results. RESULTS: The clinical examination and US gave similar results in 194 MTP joints, whereas they differed in the remaining 94 MTP joints, and correspondingly the results were similar in 34 TC joints and differed in 26 TC joints. The kappa coefficient between these investigations was 0.165 in MTP joints and 0.043 in TC joints, showing very poor agreement. CONCLUSION: These preliminary results showed poor agreement between the clinical assessment of swelling and effusion detected by US in MTP and TC joints. Thus US may considerably improve the diagnosis of synovitis in patients with RA.