A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis

Abstract

Objective. To develop an ultrasonographic (US) synovitis scoring system suitable for evaluation of finger joint inflammation in patients with active rheumatoid arthritis (RA) and to compare semiquantitative US scoring with quantitative US measurements.Methods. US was performed at the palmar and dorsal sides of the second through fifth metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in 10 healthy subjects and in the clinically more affected hand in 46 RA patients. Ten patients additionally underwent magnetic resonance imaging (MRI). Synovitis was measured, standardized, and scored according to a semiquantitative method. The 2 methods (semiquantitative US scoring, quantitative US) were compared and statistical cutoffs were identified using receiver operating characteristic (ROC) curve analysis. MRI results were compared with semiquantitative US scoring and quantitative US results. The optimal US scoring method from 6 joint combinations was identified (ROC curve analysis).Results. Synovitis was most frequently detected in the palmar proximal area (86% of affected joints). We found no significant differences between individual PIP joints or between individual MCP joints, indicating that all fingers within each of these joint groups should be treated equally for statistical calculations, although each joint group as a whole should be treated separately. The optimal cutoff point to distinguish between "health" and "pathology" was 0.6 mm both for MCP joints (sensitivity 94%, specificity 89%) and for PIP joints (sensitivity 90%, specificity 88%). There was no significant difference between semiquantitative US scores and quantitative US measurements. The best results for joint combinations were achieved using the "sum of 4 fingers" (second through fifth MCP and PIP joints) and "sum of 3 fingers" (second through fourth MCP and PIP joints) methods. Comparison of MRI results with semiquantitative US scores revealed high concordance.Conclusion. US evaluation of finger joint synovitis can be considerably simplified by focusing on the palmar side and by applying semiquantitative grading instead of quantitative measurements. For evaluation of treatment efficacy based on synovitis in RA patients, we recommend using the "sum of 3 fingers" method in longitudinal trials.

Power doppler ultrasonographic monitoring of response to anti–tumor necrosis factor therapy in patients with rheumatoid arthritis

“…The US scanning method has been described previously (5,10,14,16,33,34). Synovitis, tenosynovitis, and bursitis were defined according to the Outcome Measures in Rheumatology Clinical Trials published definitions and descriptions (14,16,35,36).…”

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

“…Of 3004 studies identified initially, 14 articles were selected to be included in the review 8,9,14,25,26,27,28,29,30,31,32,33,34,35 . Table 1 shows the study design characteristics of the studies.…”

“…The on October 31, 2016 -Published by www.jrheum.org Downloaded from based on suggested frequency of involvement 25 , feasibility 8 , or representative value of target joints 9 , or were developed in a logistic regression model 26 . Two reduced joint counts seemed to present good validity issues: the 12-joint count proposed by Naredo, et al 26 and the 7-joint count by Backhaus, et al 25 .…”

“…At the single-joint level, synovitis and effusion in GS were initially evaluated by binary grading (presence/absence) 7 . This was followed by the creation of several semiquantitative scoring systems 8,9 , which rated individual synovial hyperthrophy and effusion as well as the combination thereof. Additional studies utilized quantitative measurements for evaluating synovitis in GS, based on the volume/depth of synovial tissue 8,10 .…”

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

“…In order to quantify the pathologic changes in single joints, synovitis may be evaluated by binary grading (presence/absence), semiquantitative scoring (scales), and quantitative measurements (volume/depth of synovial tissue), both in gray-scale (GS) (8,(13)(14)(15) and also by using color/power Doppler (PD) flow assessment (16 -23). 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).…”