First step in the development of an ultrasound joint inflammation score for rheumatoid arthritis using a data-driven approach

Aga, Anna‐Birgitte; Hammer, Hilde Berner; Olsen, I.C.; Uhlig, Till; Kvien, Tore K; Heijde, Desirée van der; Fremstad, Hallvard; Madland, Tor Magne; Lexberg, Åse Stavland; Haukeland, Hilde; Rødevand, Erik; Høili, Christian; Stray, Hilde; Bendvold, Anne Noraas; Soldal, D.M.; Bakland, Gunnstein; Lie, Elisabeth; Haavardsholm, Espen A

doi:10.1136/annrheumdis-2015-207572

Cited by 13 publications

(17 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The more comprehensive the US examination, the more sensitive it is in detecting change 51. However, reduced-joint US assessments have also shown a good sensitivity,47 48 55 60 61 focusing either on a few target joints such as the wrist, metacarpophalangeal and metatarsophalangeal joints or on a few small joints plus one or two large joints 47 48 55 60 62…”

Section: Resultsmentioning

confidence: 99%

Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission

D'Agostino¹,

Terslev

Wakefield

et al. 2016

Ann Rheum Dis

View full text Add to dashboard Cite

The absence of specific guidance on how to use US to diagnose and manage patients with inflammatory arthritis, especially with rheumatoid arthritis (RA) has hindered the optimal utilisation of ultrasound (US) in clinical practice, potentially limiting its benefits for patient outcomes. In view of this, a group of musculoskeletal US experts formed a working group to consider how this unmet need could be satisfied and to produce guidance (additional to EULAR imaging recommendations) to support clinicians in their daily clinical work. This paper describes this process and its outcome, namely six novel algorithms, which identify when US could be used. They are designed to aid diagnosis, inform assessment of treatment response/disease monitoring and to evaluate stable disease state or remission in patients with suspected or established RA, by providing a pragmatic template for using US at certain time points of the RA management. A research agenda has also been defined for answering unmet clinical needs. D A ARD-2016-209646 revised clean version 3Recently, the European League Against Rheumatism (EULAR) has produced recommendations for using imaging in rheumatoid arthritis (RA) management to aid diagnosis, assessment of prognosis, assessment of treatment response/disease activity and to support remission surveillance. 1 How these recommendations should be applied, however, is open to interpretation.Among the different imaging techniques, ultrasound (US) has shown to be of particular help in the diagnostic work-up of RA, in guiding treatment decisions and in monitoring disease activity and remission. Despite the difference in the quality of the US machines 2-4 and the possible different level of experience of the operators, published data supports the value of using US in the management of patients with inflammatory arthritis. 1 5 This evidence has encouraged many rheumatologists to embrace US in their clinical practice. 6 The expansion of US in rheumatology has occurred alongside, and is complementary to, the acceptance of the treat-to-target model, in which disease activity and response to treatment must be closely monitored. 7 The prompt diagnosis of RA and early initiation of disease-modifying anti-rheumatic drugs (DMARDs) reduce inflammation, limit disease progression, control symptoms and minimise functional loss. [8][9][10] According to the American College of Rheumatology (ACR)/EULAR classification criteria, 11 a patient with synovitis can be classified as having RA if a certain number of joints with synovitis are detected or if bone erosions are present. However, clinical examination and conventional radiography (CR) are neither sensitive nor accurate enough to detect disease activity and structural damage in early disease. [12][13][14][15] In contrast, US is able to detect synovitis at presentation and differentiate between intra-joint synovial inflammation and other causes of symptoms/swelling, such as tenosynovitis, bursitis and other soft tissue lesions. [16][17][18][19][20] This is also reflect...

show abstract

Section: Resultsmentioning

confidence: 99%

Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission

D'Agostino¹,

Terslev

Wakefield

et al. 2016

Ann Rheum Dis

View full text Add to dashboard Cite

show abstract

“…Using a data-driven approach, the same group of authors set out to validate a new MSUS score in a large survey of early or established RA. The set comprising GS/pD scores of seven joints/two tendons (first and second MCP, second MCP, third PIP, radiocarpal, elbow, first and second MTP, tibialis posterior tendon, extensor carpi ulnaris tendon) preserved most of the information when compared to a 9-joint score (which added fifth MCP and fifth MTP) [100].…”

Section: Ultrasound Scoresmentioning

confidence: 99%

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

et al. 2018

View full text Add to dashboard Cite

High-resolution musculoskeletal ultrasound (MSUS) has been increasingly employed in daily rheumatological practice and in clinical research. In rheumatoid arthritis (RA), MSUS can be now considered a complement to physical examination. This method evaluates synovitis through gray-scale and power Doppler and it is also able to identify bone erosions. The utilization of MSUS as a marker of RA activity has received attention in recent literature. Current data account for good correlation of MSUS with classical measures of clinical activity; in some instances, MSUS appears to perform even better. Diagnosis of subclinical synovitis by MSUS might help the physician in RA management. With some variation, interobserver MSUS agreement seems excellent for erosion and good for synovitis. However, lack of MSUS score standardization is still an unmet need. In this review, we describe several MSUS scores, as well as their correlation with clinical RA activity and response to therapy. Finally, we look at the relationship of MSUS with synovial tissue inflammation and discuss future perspectives for a better interpretation and integration of this imaging method into clinical practice.

show abstract

“…Based on these analyses, we identified groups with correlating scores to guide the selection of the final US joint set. In groups with more than one joint identified by factor analysis, the selection process was based on factor loading and previous work to identify joints that retained most information from the extensive score 6. The final US score was defined as the sum of the joint/tendon scores in the final joint set.…”

Section: Methodsmentioning

confidence: 99%

“…Our research group recently developed two candidate sets of reduced US joint inflammation scores in early RA through a data-driven approach in cross-sectional data, aiming to retain as much information as possible from the full score 6. The candidate scores performed well in a validation cohort of established RA, and performed better than previously proposed reduced joint scores 3–5.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

Self Cite

View full text Add to dashboard Cite

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.

show abstract

First step in the development of an ultrasound joint inflammation score for rheumatoid arthritis using a data-driven approach

Abstract: NCT01205854, ACTRN12610000284066.

Cited by 13 publications

References 31 publications

Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission

Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

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

Contact Info

Product

Resources

About