Development of a feasible and responsive ultrasound inflammation score for rheumatoid arthritis through a data-driven approach

Abstract

ObjectiveTo develop and validate a responsive and feasible ultrasound inflammation score for rheumatoid arthritis (RA).MethodsWe used data from cohorts of early RA (development) and established RA starting/switching biologic therapy (validation). 4 tendons and 36 joints were examined by a grey scale (GSUS) and power Doppler semiquantitative ultrasound (PDUS) scoring system (full score). Ultrasound score components were selected based on factor analyses of 3-month change in the development cohort. Responsiveness was assessed by standardised response means (SRMs). We assessed the proportion of information retained from the full score by linear regression.Results118 patients with early and 212 patients with established RA were included. The final ultrasound score included 8 joints (metacarpophalangeal 1–2–3, proximal interphalangeal 2–3, radiocarpal, metatarsophalangeal 2–3) and 1 tendon (extensor carpi ulnaris) examined bilaterally. The 6-month SRMs for the final score were −1.24 (95% CI −1.47 to −1.02) for GSUS, and −1.09 (−1.25 to −0.92) for PDUS in early RA, with 87% of total information retained for GSUS and 90% for PDUS. The new score performed somewhat better than formerly proposed scores in the validation cohort.ConclusionsThe Ultrasound in Rheumatoid Arthritis 9 joint/tendon score (USRA9) inflammation score showed good responsiveness, retained most of the information from the original full score and overall performed better than previous scores in a validation cohort.Trial registration numbersNCT01205854, ACTRN12610000284066; Post-results.

Assessing synovitis in the hands in patients with rheumatoid arthritis by ultrasound: an agreement study exploring the most inflammatory active side from two Norwegian trials

“…Scoring synovitis unilaterally will by far reduce the examination time [9], and the unilateral 7-joint count by Backhaus et al [7] is often used in trials. In unilateral scoring systems, the suggestion is to choose either the dominant side [7, 8] or the clinically most affected side defined as the hand with the most tender and/or swollen joints [9, 14, 15].…”

“…Scoring synovitis unilaterally will by far reduce the examination time [9], and the unilateral 7-joint count by Backhaus et al [7] is often used in trials. In unilateral scoring systems, the suggestion is to choose either the dominant side [7, 8] or the clinically most affected side defined as the hand with the most tender and/or swollen joints [9, 14, 15]. The dominant side is also commonly the chosen side in magnetic resonance imaging (MRI), where only one side can be evaluated at a time and is based on data showing that the dominant hand has more erosions on X-ray than the non-dominant hand both at baseline and follow-up [16, 17].…”

Value of Contrast-Enhanced Ultrasonography in Evaluating Rheumatoid Arthritis: Preliminary Research Based on an Animal Model

“…As stated in the RA chronic disease management guide, the true state of RA improvement includes not only the disappearance of clinical symptoms and the dissipation of inflammation but also the improvement of joint outcomes and functions, resulting in the improvement of quality of life [ 24 ]. Therefore, imaging is playing an increasingly important role in the diagnosis of RA and its follow-up assessment [ 25 – 28 ]. Ultrasound has the inherent advantage of being convenient and cost-effective.…”

Predicting Imaging Remission in Rheumatoid Arthritis: a Case-control Ultrasound Study

“…A US was performed by a single experienced sonographer on 16 joints and 2 tendons using the published USRA9 definitions. 19 This included the metacarpophalangeal (MCP) 1–3, proximal interphalangeal (PIP) 2–3, radiocarpal (RC), metatarsophalangeal 2–3, and extensor carpi ulnaris tendon bilaterally. There were no changes in the US settings during the study and no software upgrades.…”