Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

Abstract

Objective. To introduce and evaluate a new standardized ultrasound (US) score developed for large joints in patients with rheumatoid arthritis (RA). Methods. A US score was designed to determine the degree of inflammation in the shoulder, the elbow, the hip, and the knee joint in patients with RA (Sonography of Large Joints in Rheumatology [SOLAR] score). Synovitis and synovial vascularity were scored semiquantitatively (grade 0 -3) by gray-scale US (GSUS) and power Doppler US (PDUS). Patients with RA were examined at baseline and 3, 6, and 12 months after initiation of local or systemic therapy (diseasemodifying antirheumatic drugs [DMARDs]/biologic agents). Erythrocyte sedimentation rate, anti-cyclic citrullinated peptide antibodies, and the clinical Disease Activity Score in 28 joints (DAS28) were determined. Results. A cohort of 199 patients were analyzed and followed up over 12 months. At baseline, before modification of the therapy, patients received either DMARDs (n ‫؍‬ 131), DMARDs plus biologic agents (n ‫؍‬ 46), biologic monotherapy (n ‫؍‬ 8), or no DMARD therapy (n ‫؍‬ 14). At baseline, the mean DAS28 score was 4.6 and decreased to 3.2 after 1 year of therapy (P < 0.001). All US scores demonstrated a statistically significant improvement except for the PDUS scores for the shoulder and the hip. In detail, the mean synovitis GSUS score for the knee decreased from 5.2 at baseline to 2.2 after 12 months of followup. The mean GSUS score for the shoulder fell from 2.6 to 1.6, for the elbow fell from 5.2 to 2.6, and for the hip fell from 2.2 to 0.4 (P < 0.05 for each). Conclusion. The SOLAR score is a feasible tool for the qualitative and quantitative evaluation of large joint involvement in patients with RA using US.

The role of ultrasonography in assessing disease activity in patients with rheumatoid arthritis and associated fibromyalgia

“…A total of 12 tendons were scanned for the detection of TS. Large joints were scanned according to the SOLAR score: shoulder -glenohumeral posterior transverse, axillary longitudinal (2 scans), elbow -humeroradial, humeroulnar, olecranon fossa (3 scans), knee -suprapatellar longitudinal, medial, and lateral femurotibial, dorsal longitudinal (4 scans) [12]. A total of 42 scans/ patient at joints level were obtained.…”

“…The most widely used scoring system for small joints and tenosynovitis is the one proposed by Backhaus et al [11]. The Sonography of Large Joints in Rheumatology (SOLAR) is the only validated score that evaluates semiquantitatively GS and PD in large joints [12].…”

Knee ultrasound from research to real practice: a systematic literature review of adult knee ultrasound assessment feasibility studies.

“…However, we decided to score this area of focus with one point, while we gave no points for the Adaptation domain, even though the authors tackled this area by recommending further studies including more joints. Notwithstanding the low score this paper obtained (less than half of the maximum score and equal to the one given to other 5 different articles [11,12,15,[17][18]), it is the only one of the publications we selected that took into account a wider range of feasibility aspects, closer to the way we envisage a MSUS feasibility study should be conducted. Moreover, the points given to the papers based on the study of US scores, were assigned mainly due to some overlap between two of the domain's outcomes of interest (inter-rater and intra-rater reliability, score sensitivity to change and assessment duration could represent outcomes of interest to both Implementation and Practicality) and the fact that we considered the US score testing itself as addressing the Demand domain.…”

“…Six out of the nine analysed studies focused on validating US scores and quantified feasibility as time spent for the US examination, disregarding any other feasibility related aspects [11,12,[15][16][17][18]. In one of the studies, the main objective was to investigate the feasibility of US guided knee intra-articular injections [14], but in the results section the authors refer to feasibility exclusively as the accuracy of the technique.…”

“…The results of the semi-quantitative evaluation of the selected papers, as detailed in the Methods section above, are as follows: the highest score (3) was obtained by 6 of the papers [10][11][12]15,17,18], while two publications scored one point each [13,16] and one received 2 points [14]. Based on the set of focus areas previously mentioned, none of the works included in the final analysis practiced a systematic assessment of all feasibility domains, acquiring less than half of the maximum score we proposed.…”