LONG-TERM SONOGRAPHIC FOLLOW-UP OF RHEUMATOID AND PSORIATIC PROLIFERATIVE KNEE JOINT SYNOVITIS

The potential role of sonography in evaluating the responseto therapy of persistent knee joint synovitis (KJS) was assessedin a longitudinal study in pre- and post-arthroscopic (AS) synovectomyin rheumatoid and psoriatic patients. At entry to the study,ultrasound (US) detection of synovial proliferation was comparedwith arthroscopic visualization as the ‘gold standard’reference. US joint effusion and synovial thickness measuresand predominant patterns of synovial proliferation were recordedby comparing clinical and US indices before and at 2, 6 and12 months after AS synovectomy, or after KJS relapse up to 24months. A 12 month survival analysis of clinical and US outcomesof arthroscopic synovectomy was also performed. US detectionof morphology and degree of synovial proliferation was correlatedwith AS macroscopic evaluation. After AS synovectomy, the clinicalindex and both US joint effusion and synovial thickness weresignificantly reduced, whereas US patterns of synovial proliferationdid not show significant changes. US and clinical indices weresignificantly correlated in all follow-up measurements and USjoint effusion was significantly increased in the relapsed comparedwith the non-relapsed KJS group. The probability at 12 monthsof reaching maximum improvement in US joint effusion and synovialthickness outcomes was 99 and 58%, respectively; that for clinicalremission of KJS was 72%. Ultrasound evaluation has proven reliableand accurate by the arthroscopic gold standard in detectingchanges of rheumatoid arthritis and psoriatic arthritis kneejoint synovitis. The correlation of US with clinical findingsin pre- and post-synovectomy patients suggests that sonographycan be used as an objective method in monitoring the responseto therapy of inflammatory knee joint disease. KEY WORDS: Knee joint synovitis, Arthroscopic synovectomy, Sonographic follow-up