1. Sidra Hussain, Priyanka Sivakumaran Coziana Ciurtin
Key differences between osteoarthritis and seropositive rheumatoid arthritis on hand ultrasound
Sidra Hussain, Priyanka Sivakumaran
Coziana Ciurtin

2. Background
Ultrasound (US): low cost and effective way to discriminate normal from early inflammatory arthritis joints
Positive Doppler (PD) signal indicate active joint inflammation and synovial hypertrophy (SH) and joint effusions are additional inflammatory changes.
Inflammatory markers being greater on US in erosive osteoarthritis (EOA) compared to non-EOA , suggesting EOA may have some systemic inflammatory component.
Can we differentiate between OA and RA patients based on these measurements?
Patient age
Inflammatory markers (ESR and CRP)
Synovial hypertrophy, positive Doppler signal
Osteophytes (OP) and erosions
Tender joint count (TJC), swollen joint count (SJC) and global assessment score (GVAS)

3. Methods
Imaging: 299 patients  42 OA and 108 RA  Blood tests  US  joint system analyse data Retrospective study Logiq S8 (GE Medical Systems Ultrasound and Primary Care Diagnostics)

4. Results
P =<0.05 denoted with: * * * *

5. Results
P =<0.05 denoted with: * * * *

6. Discussion/Conclusion
Findings are consistent with current knowledge of RA as an inflammatory arthritis, with more evidence of inflammatory changes on US (synovial hypertrophy, positive Doppler and erosions), as well as on CJE (higher SJC).
OA is a degenerative condition, which is reflected by the older age of sufferers. Osteophytes are more likely to be present in US of patients with OA compared to RA.
Conclusion
Further work is needed to establish whether there can be a clear cut-off for the number of joints with inflammatory changes on US (e.g. effusions, positive Doppler, synovial hypertrophy) that definitively distinguish between hand OA and RA.

7. References
Millot F, Clavel G, Etchepare F, et al. Musculoskeletal ultrasonography in healthy subjects and ultrasound criteria for early arthritis (the ESPOIR cohort). J Rheumatol. 2011;38(4):
Tan YK, Østergaard M, Conaghan PG. Imaging tools in rheumatoid arthritis: ultrasound vs magnetic resonance imaging. Rheumatology (Oxford). 2012;51 Suppl 7:vii36-42.
Szkudlarek M, Wakefield RJ, Backhaus M, Terslev L. The discriminatory capacity of ultrasound in rheumatoid arthritis: active vs inactive, early vs advanced, and more. Rheumatology (Oxford). 2012;51 Suppl 7:vii6-9.
Kortekaas MC, Kwok WY, Reijnierse M, Huizinga TW, Kloppenburg M. In erosive hand osteoarthritis more inflammatory signs on ultrasound are found than in the rest of hand osteoarthritis. Ann Rheum Dis. 2013;72(6):930-4.

8. Thank you Any questions?