Knee pain in OA is associated with BML and effusion/synovitis suggesting that these features may indicate the origin of pain in knee OA. However, due to the moderate level of evidence these features need to be explored further.

GS synovitis, effusion, synovial thickening and PDS are associated with pain in HOA, suggesting a role for inflammation. Further follow-up studies are warranted.

Objectives: Painful osteoarthritis (OA) of the hand is common and a validated ultrasound (US) scoring system would be valuable for epidemiological and therapeutic outcome studies. US is increasingly used to assess peripheral joints, though most of the US focus in rheumatic diseases has been on rheumatoid arthritis. We aimed to develop a preliminary US hand OA scoring system, initially focusing on relevant pathological features with potentially high reliability. Methods: A group of experts in the fields of OA, US and novel tool development agreed on domains and suggested scaling of the items to be used in US hand OA scoring systems. A multi-observer reliability exercise was then performed to evaluate the draft items. Results: Synovitis (grey scale and Power Doppler) and osteophytes (representing activity and damage domains) were included and evaluated as the initial components of the scoring system. All three features were evaluated for their presence/absence and if present were scored using a 1-3 scale. The reliability exercise demonstrated intrareader k values of 0.444-1.0, 0.211-1.0 and 0.087-1.0 for grey scale synovitis, power Doppler and osteophytes respectively. Inter-reader reliability k values were 0.398, 0.327 and 0.530 grey-scale synovitis, power Doppler and osteophytes respectively. Without extensive standardisation, both intra-and inter-reader reliability were moderately good. Conclusions:The draft scoring system demonstrated substantive to almost perfect percentage exact agreement on the presence/absence of the selected OA features and moderate to substantive percentage exact agreement on semi-quantitative grading. This preliminary process provides a good basis from which to further develop an US outcome tool for hand OA that has the potential to be utilised in multicentre clinical trials.Osteoarthritis (OA) is the most common joint disease 1 and is associated with significant health economic consequences 2 3 The prevalence of radiographic OA has been well documented in epidemiological studies; however, the prevalence of symptomatic hand OA is not well documented. The Framingham study has estimated the prevalence to be as high as 26% of women and 12% of men over 70. 4 While treatment recommendations focus on a holistic approach, the pharmaceutical options are currently largely limited to analgesics [5][6][7] However, the spectrum of pharmaceutical therapies is expanding, with a recent increase in interest in potential disease modifying therapies in OA. Ultrasound (US) appears favourably placed to assess OA both in the clinic and in clinical trials. It has a higher resolution than CR, does not involve ionising radiation, and allows multi-planar, dynamic imaging of joints. In addition, recent studies in inflammatory arthritis have demonstrated US to be more sensitive to synovitis than clinical examination 11-13 more sensitive than CR to the presence of cortical defects, 14 15 and have reasonable sensitivity compared with magnetic resonance imaging for the presence of synovitis and cortical ...

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Inflammatory features, especially when persistently present, are independently associated with radiological progression in HOA after 2.3 years, indicating a role of inflammation in the aetiology of structural damage in HOA.