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Assessment of hand arterial flow pattern and change in resistive index from proximal to distal arterial segments in Rheumatoid arthritis: a case

control study

Sumantro MondalPost Doctoral trainee

Department of RheumatologyInstitute of Post Graduate Medical Education and Research,

Kolkata.

Background• Synovitis of hand joints is one of the classical features of RA,

• Assessment of synovial vascularity is an important parameter of PDUS grading of synovitis,

• However, PDUS only assess flow signals not the flow characteristics,

• Tissue inflammation is associated with changes in local blood flow pattern which can be detected by colour Doppler ultrasound (CDUS),

• This study was intended to detect the characteristics of blood flow parameters of hand arteries by CDUS, in RA patients

Materials and methods• Cross sectional study, Site: IPGME&R, Kolkata, India,• Study period: April to July 2015,

• 109 consecutive RA patients (as per ACR/EULAR 2010 classification criteria) with hand joint synovitis,• 90 age and sex matched controls,

• Exclusion criteria: (Study population with any of the followings)--

• taking any vaso-reactive drugs, presence of CVD risk factors,

• H/O Raynaud’s phenomenon,

• Past H/O any vascular surgery of upper limb,

• with any history suggestive of autonomic neuropathy

• Study Variables:

• Baseline demographic characteristics, Disease activity status, Autoantibody status (RF and anti CCP),

• CDUS of bilateral radial, ulnar, palmar and digital arteries,

• Resistive index (RI) and change in resistive index (ΔRI) from proximal to distal arteries were calculated and compared between patient and control group,

• E saote MyLab 25 Gold USG platform was used with vascular transducer,

• Setting: Vascular,

• PRF, Colour gain optimised,

Triphasic Biphasic Monophasic

PSVEDV

• Resistive Index: PSV- EDV/PSV

• ΔRI = (RI Proximal artery – RI Distal artery)/ RI (Proximal artery) x 100

Statistical analysis• Continuous variables: expressed as means (± standard deviation) for

normally distributed variables and as median (range) for non-normal data

• Categorical variables were expressed as number/percentage (95% confidence interval)

• Comparison of means: By Student's t test (normally distributed data) & Mann Whitney U test (non-normal data),

• Comparison of binomial proportions were done with Chi – squared test or Fisher’s exact test as appropriate

Results• Control group: n=90

• 70.5% female,

• Age (yr): mean: 37 ± 7.6, Median: 40 (22 – 54 years)

• Patient group: n= 109:• 74.3% female,

• Age (yr): mean: 40 ± 10.8, median: 40 (21 – 65),

• median disease duration 24 months (3 – 180),

• RF positive: 85 (78%)• Anti-CCP positive: 86 (79%)

• DAS28: mean 3.8 ± 1.7 (median: 2.6 (1.74 – 6.71),• CDAI: mean 10.8 ± 11.4 (median 3 (0 – 35)

Variables Controlsn = 90

Casesn = 109 P value

RI (Palmar) 0.77 ± 0.06 0.73 ± 0.08 0.001RI (Digital) 0.76 ± 0.04 0.68 ± 0.08 <0.001

Variables Controlsn = 90

Casesn = 109 P value

ΔRI RP 6.17 ± 4.8 14.13 ± 7.82 <0.001ΔRI UP 4.18 ± 3.86 12.66 ± 8.11 <0.001ΔRI RD 7.76 ± 4.24 20.11 ± 8.42 <0.001ΔRI UD 6.61 ± 5.64 18.7 ± 9.02 <0.001ΔRI PD 1.07 ± 7.32 6.89 ± 5.92 <0.001

Arterial Resistive indices in patient and control group:

Changes in arterial Resistive indices from proximal to distal arteries:

Conclusion

• In RA patients--intrinsic hand arteries (palmar & digital) show low resistance flow pattern—possibly reflecting adjacent tissue inflammation,

• There is significant reduction in flow resistance from proximal to distal hand arteries,

• Analysis of flow pattern of hand arteries, could be an objective surrogate

marker for underlying tissue inflammation in RA patients,

Thank you