The proposed US10 scoring system proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status.
Background About 90% of patients with rheumatoid arthritis (RA) have their feet affected during the course of the disease but its symptoms may be underestimated1. Objectives 1) To compare ultrasound (US) of the joints of asymptomatic feet in patients with RA with control feet; 2) to evaluate in patients with RA:the relationship between the joint US in the feet with disease activity, function, goniometry and radiography. Methods Fifty healthy subjects and fifty with RA, all with asymptomatic feet, had their feet joints (talocrural, talocalcaneal, talonavicular, naviculocuneiform, calcaneocuboid, 5th tarsometatarsal and I – V MTP) evaluated by US (synovitis, Power Doppler (PD) and erosion) 2,3, bilaterally (100 of each joint in each group – a total of 3600 joint recesses were evaluated). The following clinical assessment instruments were utilized: the DAS-28; HAQ and Foot Functional Index (FFI); goniometry and radiography. A 5% statistical significancewas considered. Results Higher measures were found in the RA group for synovitis (mm) in all joint recesses studied (p<0.003); for the presence of synovitis (p<0.035) (except the 5th tarsometatarsal and III MTP); for the presence of PD (p<0.029) (talocalcaneal, talonavicular, I, II, III, IV MTFs); and for the presence of erosion (p<0.003) (except in talocrural and talocalcaneal). The presence of synovitis, PD, and erosion were observed in the joint recesses of the RA and control groups, respectively: 18.3% and 3.05% (p<0.001), 5.77% and 0.22% (p<0.001) and 34.45% and 2.85% (p<0.001). Higher values of DAS-28, HAQ and FFI were associated with the ultrasonographic findings in some joints (p<0,046). The interobserver agreement analysis showed ICC ≤0.686 for semiquantitative synovitis; ≤0.641 for quantitat≤ive synovitis; ≤0.474 for semiquantitative PD; and ≤1.000 for semiquantitative erosion. Low rates of Kappa Coehn (0.084 to 0.400) were obtained from the correlation between radiography and US. Conclusions The joint US, even in asymptomatic feet of patients with RA, showed a much larger number of inflammatory changes in current activity(synovitis, PD) and sequela changes (erosion) compared to the control feet, with good to moderate interobserver agreement. References Vainio K. The rheumatoid foot: a clinical study with pathological and roentgenological comments. Ann Chir Gynaecol Fennn Suppl. 1956; 45(1):71-3. Riente L, Sedie AD, Iagnocco A, et al. Ultrasound imaging for the rheumatologist V. Ultrasonography of the ankle and foot. Clin Exp Rheumatol. 2006; 24:493-498. Wakefield RJ, Balint PV, Szkudlarek M, et al. Proceedings from the OMERACT Special Interest Group for Musculoskeletal Ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005; 32:2485-7. Disclosure of Interest None Declared
Background Previous reports have described the use of ultrasound (US) scores to evaluate rheumatoid arthritis (RA). However, no previous studies have used the ultrasound assessment of the hand and wrist joints for diagnosis of early RA patients. Objectives To evaluate the value of a new standardized ultrasound score based on 10 joints of the hand and wrist for diagnosis and assessment of early RA patients. Methods Fifty-one early RA patients without any disease-modifying antirheumatic drug (DMARD) treatment were enrolled on the study. The patients underwent ultrasound (US) examinations by 10 ultrasound score using a MyLab60 (Esaote, Biomedica – Genoa, Italy), equipped with a broadband linear probe (6-18 MHz). The following joints of both hands were assessed (918 joint recesses): wrist (radiocarpal, midcarpal and ulnocarpal joints), second and third metacarpophalangeal and proximal interphalangeal joints. Synovitis and synovial vascularity were scored semiquantitatively (grade 0–3) by gray-scale (GS) and power Doppler (PD) ultrasound respectively. The scoring range was 0–18 for the “presence” of GS synovitis (GSUS) and PD synovitis (PDUS) and the range was 0-54 for the semiquantitative scoring system of GS (GSSQ) and PD (PDSQ). Another physician (blinded for ultrasound examinations) performed disease activity assessment using DAS28 and the SDAI. The laboratory evaluation was obtained with C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR). Results The mean ± duration of the symptoms was 7,58 (±3,59) months, all patients have high activity disease with mean ± DAS 28 of 6,50 (±1,29) and SDAI of 46,44 (±16,52). The mean ± CRP level was 14,17 (±1,29) mg/L and the mean ± ESR level was 30,78 (±26,07) mm/hour. The mean ± GSUS, PDUS in the 10 joints was 12,47 (±2,76) and 6,72 (±4,17), respectively. The mean ± GSSQ was 27,21 (±8,99) and the mean ± PDSQ was 13,05 (±8,29). There was no correlation between GSUS or GSSQ and DAS28, SDAI and ESR. However, a significant correlation was observed between GSUS and GSSQ and CRP (r=0.368, p<0.05; r=0.326, respectively). There was a significant correlation between PDUS and DAS 28, SDAI, ESR and CRP (r=0.330, p<0.05; r=0.316, p<0.05; r=0.343, p<0.05, r=0.527, p<0.05, respectively). Also there was a correlation between the PDSQ and DAS28, SDAI, ESR and CRP. (r=0.304, p<0.05; r=0.288, p<0.05; r=0.307, p<0.05, r =0. 537 p<0.05, respectively). Conclusions There was significant correlation between the synovial vascularity (PDUS and PDSQ) of 10 joint ultrasound assessments and disease activity in early RA patients. A 10-joint US score can be a new tool for evaluating joint inflammation and follow-up of early RA patients. References Backhaus M, Ohrndorf S et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot Project. Arthritis Rheum. 2009 Sep 15;61(9):1194-201. Perricone C, Ceccarelli F et al. The 6-joint ultrasonographic assessment: a valid, sensitive-to-change and feasible method for evaluating joint inflammation in RA. Rheu...
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