Power Doppler Ultrasonography is an Important Technique in Rheumatoid Arthritis, Ankylosing Spondylitis and Osteoarthritis Arthritis among Egyptians

Abstract

Angiogenesis is controlled by a variety of angiogenesis modulators of which VEGF is one of the most important. The increased power Doppler (PD) signals determined by ultrasonography are an indirect marker of synovial vascularity in arthritis. The aim of this study was to identify the importance of the power Doppler technique in different form of arthritis, by finding relationships of the power Doppler sonography (PDS) score with synovial VEGF and US findings (effusion, thickness). 20 rheumatoid arthritis (RA), 20 ankylosing spondylitis (AS), and 20 osteoarthritis (OA) patients with active knee arthritis were included. Synovial effusion, synovial hypertrophy, and PD signal scores were calculated in arthritic joints. Synovial vascular endothelial growth factor (VEGF) fluid samples were studied. Comparisons between the groups were made; the synovial hypertrophy score and effusion scorewere significantly higher in RA and spondylarthritis than in OA. PD scores were significantly different between the groups. Synovial VEGF levels were significantly higher in patients with RA and AS than in OA. Synovial effusion score and synovial hypertrophy score were positively correlated with VEGF levels. Also a significant correlation was found between PD score and VEGF, synovial effusion and thickness. In large joints like the knee, detecting PD signals alone was sufficient to assess the angiogenesis, and there were significant positive correlations with VEGF, effusion and thickness score. Therefore, when investigating knee arthritis, the PD technique should be employed.

Zusammenfassung

Die Angiogenese wird durch zahlreiche Modulatoren, von denen VEGF der wichtigste ist, kontrolliert. Bei Arthrose ist das verstärkte Power-Doppler-Signal ein indirekter Marker für die Vaskularisierung der Synovialis. In der vorliegenden Studie sollte die Bedeutung der Power-Doppler-Sonografie bei verschiedenen Formen der Arthrose ermittelt werden. Dazu wurde der Zusammenhang zwischen dem Score der Power-Doppler-Sonografie (PDS), dem VEGF-Spiegel der Synovia und dem Ultraschallbefund der Synovialis (Erguss, Hypertrophie) bestimmt. Die Studieerfolgte an jeweils 20 Patienten mit rheumatoider Arthritis (RA), Spondylitis ankylosans (AS) und Arthrose (OA) mit aktiver Gonarthrose. Ermittelt wurden der Ausmaß des Gelenkergusses und der Hypertrophie der Synovialis sowie die PD-Signal-Scores. Außerdem wurde in Synoviaproben die Konzentration von Vascular Endothelial Growth Factor (VEGF) bestimmt. Anschließend wurden Gruppenvergleiche durchgeführt. Der Hypertrophie-Score der Synovialis und der Gelenkerguss-Score waren bei rheumatoider Arthritis und Spondylitis signifikant höher als bei Arthrose. Auch die PD-Scores unterschieden sich signifikant zwischen den Gruppen. Die Konzentrationen von VEGF in der Synovia waren bei Patienten mit rheumatoider Arthritis und Spondylitis signifikant höher als bei Arthrose. Der Gelenkerguss-Score und der Hypertrophie-Score der Synovialis korrelierten positiv mit den VEGF-Spiegeln. Außerdem bestand ein signifikanter Zusammenhang zwischen dem PD-Score und VEGF, sowie dem Gelenkerguss und der Dicke. In großen Gelenken, wie dem Knie, reichte der Nachweis von PD-Signalen alleine schon aus, um die Angiogenese zu beurteilen und bestand ein signifikanter positiver Zusammenhang mit dem VEGF-Spiegel, dem Gelenkerguss-Score und dem Hypertrophie-Score. Daher sollte bei der Untersuchung der Gonarthrose eine PD-Sonografie durchgeführt werden.

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