Does rheumatoid synovitis activity vary during the day? Evaluation with color doppler sonography

Area of Science:

• Rheumatology
• Medical Imaging

Background:

• Rheumatoid arthritis (RA) is characterized by joint inflammation.
• Clinical symptoms and synovitis activity in RA can exhibit diurnal variations.
• Doppler ultrasound (US) is used to assess synovitis activity.

Purpose of the Study:

• To investigate whether Color Doppler (CD) scores of synovitis in rheumatoid arthritis (RA) patients change throughout the day.
• To determine if diurnal variations in synovitis activity are influenced by corticosteroid use.

Main Methods:

• 27 patients with active RA were evaluated.
• Ultrasound (US) assessments, including grey scale and Color Doppler (CD), were performed twice daily (morning and evening).
• Synovitis severity was graded based on CD flow (S0-S3).

Main Results:

• Synovitis was detected more frequently in the evening than in the morning (39% vs. 33%, p=0.02).
• This diurnal increase was significant in patients not receiving corticosteroids.
• Increased CD-positive joints and more moderate/pronounced synovitis were observed in the evening, especially in dominant hands and in patients without corticosteroids.

Conclusions:

• Synovitis and CD activity demonstrably increase during the day in RA patients.
• The diurnal increase in synovitis is more pronounced in patients not on corticosteroids.
• Dominant hand joints show a greater evening increase in synovitis activity.