Hand Tendon Involvement in Rheumatoid Arthritis: An Ultrasound Study Emilio Filippucci, MD, PhD,* Alessandra Gabba, MD, † Luca Di Geso, MD,* Rita Girolimetti, MD,* Fausto Salaffi, MD, PhD,* and Walter Grassi, MD, PhD* Objective: To assess the prevalence and the distribution of tendon involvement in the hands and wrists of patients with rheumatoid arthritis (RA) describing in detail the ultrasound (US) mor- phostructural and vascular tendon abnormalities. Methods: Ninety consecutive RA patients were included in the study. The following tendons were scanned bilaterally: flexor pollicis longus tendon, flexor digitorum superficialis, and profundus tendons of the II to the V fingers (at both finger and carpal tunnel levels), flexor carpi radialis tendon, and extensor tendons of the 6 compartments on the dorsal aspect of the wrist. The presence of US findings indicative of tenosynovitis and tendon damage was investigated. Results: Tenosynovitis was found in at least 1 anatomic site of 44 (48.8%) of 90 patients. Tendon damage was found in at least 1 anatomic site of 39 (43.3%) of 90 patients. The focal tendon echotexture derangement was found in 294 of 5400 (5.4%) tendons, the partial and complete tears in 14 (0.3%), and in 3 (0.06%) tendons, respectively. The most frequently involved tendons were the flexor tendons of the II, III, and IV fingers and the extensor carpi ulnaris tendon. Conclusions: The present study provides evidence in favor of the ability of US to reveal a relatively high frequency of tendon involvement at the hand and wrist level in RA patients. These data can both facilitate US examinations in daily clinical practice and direct further investigations in the US assessment of tendon involvement in RA. © 2012 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 41:752-760 Keywords: ultrasonography, tendons, rheumatoid arthritis, power Doppler, hand I n rheumatoid arthritis (RA), tendon pathology is a well-recognized, but underestimated aspect of the dis- ease, which may lead to irreversible functional im- pairment and consequent disability (1-3). Over the last 10 years, a growing number of studies have been conducted aimed at defining the role of ul- trasound (US) in the assessment of RA (4-12). Al- though high-resolution US has been indicated as the reference imaging technique for evaluating tendons (13), most of the studies focused on the ability of US to detect and score joint inflammation and bone erosions, being that tendon involvement has not been adequately investigated. The main aim of the present study was to assess the prevalence and the distribution of tendon involvement in the hands and wrists of patients with RA, describing in detail the US morphostructural and vascular tendon ab- normalities. Additionally, we investigated the relation- ship between US findings and clinical data, and we calcu- lated the interobserver reliability of US in the assessment of tendon involvement. METHODS Patients Ninety consecutive RA patients attending the outpatient and inpatient clinics at the Rheumatology Department of the Università Politecnica delle Marche, Italy were in- cluded in the study. All patients fulfilled the American College of Rheumatology criteria for the diagnosis of RA *Clinica Reumatologica, Università Politecnica delle Marche, Ancona, Italy. †Cattedra di Reumatologia, Dipartimento di Scienze Mediche, Università di Cagliari, Cagliari, Italy. Address reprint requests to Emilio Filippucci, MD, PhD, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale “Augusto Murri”, Via dei Colli, 52, 60035 Jesi (Ancona), Italy. E-mail: emilio_filippucci@yahoo.it. RHEUMATOID ARTHRITIS 752 0049-0172/12/$-see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.semarthrit.2011.09.006