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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:1193-1199 • 0278-4297

Association of Ultrasonographic Findings of Synovitis With Anti–Cyclic Citrullinated Peptide Antibodies and Rheumatoid Factor in Patients With Palindromic Rheumatism During Active Episodes

Hsin-Hua Chen, MD, Joung-Liang Lan, MD, Guo-Dung Hung, MD, Yi-Ming Chen, MD, Howard Haw-Chang Lan, MD and Der-Yuan Chen, MD, PhD

Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine (H.-H.C., J.-L.L., G.-D.H., Y.-M.C., D.-Y.C.), and Department of Radiology (H.H.-C.L.), Taichung Veterans General Hospital, Taichung, Taiwan; National Yang-Ming University, Taipei, Taiwan (H.-H.C., J.-L.L., Y.-M.C., D.-Y.C.); National Chung-Hsing University, Taichung, Taiwan (H.-H.C., J.-L.L., Y.-M.C., D.-Y.C.); Central Taiwan University of Science and Technology, Hungkuang University, Taichung, Taiwan (H.H.-C.L.); and Hungkuang University, Taichung, Taiwan (H.H.-C.L.).

Address correspondence to Der-Yuan Chen, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Section 3, Taichung-Kang Rd, 40705 Taichung, Taiwan. E-mail: dychen{at}vghtc.gov.tw

Objective. The purpose of this study was to investigate whether the presence of ultrasonographic findings of synovitis is associated with the presence of anti–cyclic citrullinated peptide (CCP) antibodies and rheumatoid factor (RF) in patients with palindromic rheumatism (PR) during active episodes. Methods. Clinically involved regions of 84 patients with PR during active episodes were examined with high-resolution ultrasonography. Serum levels of anti-CCP antibodies were determined by an enzyme-linked immunosorbent assay, and RF levels were measured by nephelometry. Results. Thirty patients (36%) had ultrasonographic findings of synovitis during active episodes. Significantly higher positive rates of anti-CCP antibodies and RF were observed in patients with PR who had ultrasonographic findings of synovitis compared with those who had no ultrasonographic findings of synovitis (26.7% versus 5.6%; odds ratio, 6.18; P < .05; and 30.0% versus 5.6%; odds ratio, 7.29; P < .01, respectively). The intraobserver and interobserver agreement for the detection of synovitis and Doppler signals by ultrasonographic assessment was excellent. Conclusions. Ultrasonography is a reliable method for assessing the presence of synovitis in patients with PR during active episodes. The ultrasonographic findings of synovitis are associated with the presence of anti-CCP antibodies and RF in patients with PR.

Key Words: anti–cyclic citrullinated peptide antibodies • palindromic rheumatism • rheumatoid factor • ultrasonography

Abbreviations: CCP, cyclic citrullinated peptide • CRP, C-reactive protein • HCQ, hydroxychloroquine • IQ, interquartile • MSUS, musculoskeletal ultrasonography • PDUS, power Doppler ultrasonography • PR, palindromic rheumatism • RA, rheumatoid arthritis • RF, rheumatoid factor

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