A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter

Abstract

Objective. The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of synovitis in RA, a systematic analysis of the literature was performed. Methods. A systematic literature search of Pubmecl and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of synovitis. Results. Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination. Conclusions. Ultrasound can be regarded as a valuable tool for globally examining the extent of synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed. (J Rheumatol 2011; 38:2055-62; doi:10.3899/jrheum.110424

The OMERACT Ultrasound Task Force — Status and Perspectives

“…For this objective, further evaluation is needed of how many and what joints should be assessed and how to produce a cumulative score. The results of a systematic review in the field of previous ultrasound scoring systems of synovitis in RA were presented (e.g., joint studied, grading used, construct and predictive validity, discrimination, and feasibility) dur-ing the Sharp symposium 15 . The results from 2 published multicenter longitudinal studies were discussed in more detail.…”

Clinical and Ultrasound‐Based Composite Disease Activity Indices in Rheumatoid Arthritis: Results From a Multicenter, Randomized Study

“…In recent years, several global ultrasound synovitis scoring systems that aim to assess synovitis on the patient level as opposed to the level of single joints have been developed and validated (24). Scores based on a reduced number of joints have shown a similar correlation with clinical and laboratory parameters as the corresponding 60-joint evaluation (25)(26)(27).…”

Trend of the Same Synovitis Changes in Rheumatoid Arthritis on Biological Therapy: Do we Really Need a Comprehensive US Assessment of Joints?

“…Many scoring methods have strived to reduce joint counts at B-mode and Doppler synovitis as surrogates for comprehensive US assessment for monitoring [11,[16][17][18] or diagnosing RA [19]. Ultrasonographic (US) assessment has been shown to be useful in the management of RA and for monitoring the disease course [20].…”