A study of hand arthritis in systemic lupus erythematosus from a clinical, imaging and cytokine perspective

Joint involvement in Systemic Lupus Erythematosus (SLE) is very common. Despite this it remains largely understudied in comparison to the abundance of research that exists in rheumatoid arthritis. Newer imaging techniques including Ultrasound and MRI are challenging the traditional concepts of a 'non-erosive arthropathy' (or Jaccoud's arthropathy), which is outlined in the American College of Rheumatology diagnostic criteria for SLE. The aim of this study was to assess varying degrees of lupus joint disease both clinically, radiologically and from an antibody and cytokine perspective. Fifty patients with a definite diagnosis of SLE and who complained of painful hands for> 1 year were recruited and included in the study. Forty patients with rheumatoid arthritis (RA) were also recruited as a comparator group. Lupus disease activity was measured, clinical examination was carried out, C-reactive protein (CRP) and immunological tests were performed, plasma levels of IL-6, TNF-alpha and BLyS were measured. All patients underwent ultrasonography and a proportion also had a contrast enhanced Magnetic Resonance Imaging (MRI) scan of their hand. The results present a detailed ultrasound and MRI description of lupus joint involvement. Both Ultrasound and MRI examination revealed a much higher prevelance of erosive disease in the SLE cohort than previous estimates. In the SLE patients plasma IL-6 levels (unlike plasma TNF-alpha and BLyS levels) correlated with both clinical and ultrasonographic measures of arthritis disease activity. Erosive lupus joint disease was associated with higher CRP levels and was often independent of Anti-CCP antibody status. Compared with MRI as the gold-standard Musculoskeletal Ultrasound is a useful and , practical bedside tool for the assessment and classification of lupus arthritis. CRP may have potential as a biomarker for patients with more aggressive arthritis and results from this study also suggest that IL-6 may play a role in lupus arthritis pathobiology, therefore meriting further investigation as a potential therapeutic target.EThOS - Electronic Theses Online ServiceGBUnited Kingdo