A simplified and validated ultrasound scoring system to evaluate synovitis of bilateral wrists and hands in patients with rheumatoid arthritis

Sun, Xiaoying; Deng, Xuerong; Geng, Yan; Ji, Lanlan; Xie, Wenhui; Zhang, Xiaohui; Zhang, Zhuoli

doi:10.1007/s10067-017-3785-4

Cited by 12 publications

(8 citation statements)

References 23 publications

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“…As a result, these scores effectively reflect overall joint inflammatory activity in RA. Similar to Sun et al, the joints that contributed the most to the SHI and PDI were wrists, MCP2, and MCP3 39 . A reduced joint ultrasound assessment is more feasible and less time‐consuming 16–18 …”

Section: Discussionmentioning

confidence: 52%

Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long‐Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity

Massignan

Chakr

Andrade

et al. 2021

J of Ultrasound Medicine

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Objectives This study aimed to investigate the predictive value of synovitis and tenosynovitis detected by grayscale (GS) and by power Doppler (PD) ultrasound (US) in relation to failure of tapering disease‐modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients. Methods Long‐standing RA patients who de‐escalated treatment were included in this prospective cohort study. All patients underwent 3 ultrasonographic and clinical assessments, at baseline and every 3 or 4 months, over a period of 6–8 months. US investigation of 32 joints was performed. Synovitis was assessed by GS and PD semiquantitative scoring (0–3) and a global score was calculated for each individual by summing single joint scores. The presence of tenosynovitis was recorded whenever detected during ultrasound assessment. Results Thirty‐three patients completed the follow‐up period (29 women; 4 men). Eight patients (25%) relapsed. Using the optimal cutoff values determined by receiver operating characteristic curve, patients with a PD synovitis ≥1 at baseline had significantly greater chances to relapse than those without PD activity. During follow‐up, GS tenosynovitis was detected in 6 patients (5 with PD) who failed and in 3 patients (1 with PD) who succeeded in tapering therapy. Having at least 1 joint with PD synovitis resulted in a relative risk of 3.14 and having GS tenosynovitis resulted in a relative risk of 11.4 (95% CI: 1.03–9.60 and 2.82–45.9, respectively) for relapse in the multivariate Poisson model. Conclusions PD synovitis and GS tenosynovitis may be useful to identify RA patients in risk of relapse after DMARD tapering.

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Section: Discussionmentioning

confidence: 52%

Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long‐Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity

Massignan

Chakr

Andrade

et al. 2021

J of Ultrasound Medicine

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“…The MCP joints also showed higher correlation coefficient between PD score and clinical disease activity indices, except for MCP1 joint. In our previous study of developing a simplified ultrasound scoring system in RA, MCP2, MCP3 and MCP5 joints were also identified as their highest frequencies of both positive GS and PD synovitis, and their highest sensitivity and negative predictive value among all the wrist and hand joints [14]. Both studies suggested that MCP joints are most frequently involved and most representative of synovitis among all small joints of hand and foot in RA patients, especially MCP2, MCP3 and MCP5 joints.…”

Section: Demographics and Clinical Characteristics Of Patientsmentioning

confidence: 90%

“…A high-end ultrasound machine (LOGIQ E9, GE company) with corresponding linear probe (ML [6][7][8][9][10][11][12][13][14][15] was applied to scan 30 peripheral joints (bilateral MCP1-5, PIP1-5 and MTP1-5) for each patient, using both gray scale (GS) and power Doppler (PD). All ultrasound scan was performed by a ultrasonographer who has 10-years' relevant experience.…”

Section: Us Assessmentmentioning

confidence: 99%

The correlation between ultrasound-detected synovitis of small joints and the clinical disease activity in patients with rheumatoid arthritis

Deng¹,

Sun²,

Xie³

et al. 2020

Preprint

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Background: Rheumatoid arthritis (RA) is chronic inflammatory arthritis with multi-joint involvement, especially small synovial joints in hands and feet. So far, the synovitis of which joint in hands or feet is better correlated with clinical disease activity indices is unknown; the correlation of synovitis detected by ultrasound in an individual joint with global disease activity is unclear either.Objectives: To explore the correlation between the ultrasound-detected synovitis in metacarpophalangeal (MCP), metatarsophalangeal (MTP), proximal interphalangeal (PIP) joints and the clinical disease activity indices in patients with RA.Methods: 30 joints, including bilateral MCP, PIP and MTP, were scanned for synovitis by ultrasound, semi-quantitatively scored for gray scale(GS) and power Doppler(PD). The correlation between Disease Activity Score-28 joints(DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and ultrasound-detected synovitis score in each joint was assessed using Spearman's rank correlation test.Results: 211 RA patients were included in this study. The whole GS scores of all MCP joints showed highest correlation with all clinical disease activity indices (r=0.403-0.452, p<0.01), followed by PIPs (r=0.318-0.331, p<0.01) and MTPs (r=0.277-0.301, p<0.01). Likewise, the whole PD scores of all MCP joints also showed highest correlation with the disease activity (r=0.332-0.396, p<0.01), followed by PIPs (r=0.211-0.242, p<0.01), and p<0.01). The highest correlation of GS score with DAS28-ESR (r=0.411, p<0.01), DAS28-CRP (r=0.459, p<0.01), SDAI (r=0.444, p<0.01) was observed in MCP3 joint, while with CDAI (r=0.421, p<0.01) in MCP2 joint. The highest correlation of PD score with DAS28-ESR (r=0.353, p<0.01), DAS28-CRP (r=0.399, p<0.01), CDAI (r=0.368, p<0.01), SDAI (r=0.377, p<0.01) was in MCP5 joint. Conclusions:The ultrasound-detected synovitis at MCP joints, especially MCP2, MCP3, and MCP5 joints, was best correlated with composite disease activity of RA, in contrast to PIP and MTP joints.MCP joints should take greater weight in clinical disease activity assessment.

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“…Sun et al [12] presented a similar simplified system of US assessment, regarding selected hand joints in RA patients. Eight joints were assessed in some of the patients (bilateral wrist joints, MCP II, III, V), and 22 joints in the rest of the group.…”

Section: Discussionmentioning

confidence: 99%

The importance of ultrasound examination in early arthritis

Ponikowska¹,

Świerkot²,

Nowak³

2018

Reumatologia

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ObjectivesTo assess the importance of ultrasound (US) examination of joints in hands and feet in patients with early arthritis and perform comparative analysis of the diagnostic value of US examination for 8, 12 and 52 selected joints.Material and methods123 patients (87 women, 36 men) with arthritis lasting less than 12 months, naive to disease-modifying anti-rheumatic drugs and glucocorticosteroids. Necessary differential diagnostics was performed for each patient. After the preliminary analysis, 72 patients met the classification criteria for rheumatoid arthritis (RA) according to ACR/EULAR of 2010, and undifferentiated arthritis (UA) was diagnosed in 51 patients. UA patients were followed up after 6 and 12 months, and verification of the initial diagnosis yielded the following groups of patients: patients meeting classification criteria for RA, patients with maintained diagnosis of UA, patients in remission, and patients with other diagnoses. Ultrasound examination was performed considering the volume of joint effusion (JE), synovial membrane hypertrophy (GS), and synovial membrane hyperaemia assessed by power Doppler (PD). Results were assessed using the semi-qualitative scale. Coefficients being the sum of US scores for the assessment of JE, GS and PD for 52 and 12 joints in hands and feet, and 8 joints in hands were determined for the purpose of the study.ResultsIn patients meeting classification criteria for RA during the initial assessment the US examination yielded significantly higher PD-52I, PD-12I and PD-8I coefficients. In UA patients who were diagnosed with RA after 12 months, the GS-8I coefficient was significantly higher.ConclusionsUltrasonography is a valuable tool in diagnostics of early arthritis. The GS assessment has prognostic value for UA patients. The assessment of 8 or 12 selected joints is often sufficient for the diagnostics of patients with early arthritis.

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A simplified and validated ultrasound scoring system to evaluate synovitis of bilateral wrists and hands in patients with rheumatoid arthritis

Cited by 12 publications

References 23 publications

Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long‐Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity

Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long‐Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity

The correlation between ultrasound-detected synovitis of small joints and the clinical disease activity in patients with rheumatoid arthritis

The importance of ultrasound examination in early arthritis

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