Power doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: A comparison with dynamic magnetic resonance imaging

Szkudlarek, Marcin; Court‐Payen, Michel; Strandberg, Charlotte; Klarlund, Mette; Klausen, Thomas Levin; Østergaard, Mikkel

doi:10.1002/1529-0131(200109)44:9<2018::aid-art350>3.0.co;2-c

Cited by 374 publications

(201 citation statements)

References 23 publications

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“…In particular, before starting therapy, the median US global score was 21 [interquartile ranges (IQR), [18][19][20][21][22][23][24][25][26][27] and after 1 year of etanercept therapy was reduced to 11.2 (IQR, [8][9][10][11][12][13]. The evaluation of the knee joint is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

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Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

et al. 2007

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We evaluated clinically and sonographically the effects of etanercept therapy in patients with rheumatoid arthritis (RA) over 12 months of treatment. Eighteen patients affected by RAwho were non-responders or partial responders to disease modifying therapy were commenced on Etanercept treatment. Before starting therapy (T0) and at 12 months (T1), the following parameters were evaluated: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) for pain, number of painful and swollen joints, health assessment questionnaire (HAQ) and disease activity score in 28 joints (DAS 28). Musculoskeletal ultrasound (US) was performed in the following joints: second and fifth metacarpophalangeal, third interphalangeal, wrist and knee joints and a semiquantitative score (0-3) calculated and used to indicate the presence of a localised inflammatory process (synovitis, tenosynovitis, bursitis) and/or structural damage (bone erosion and cartilaginous change). An overall score was calculated based on the sum of the single scores to obtain a comprehensive score indicative of the global pathological change. The US global scores significantly reduced between T0 and T1 (p<0.0001). The following laboratory and clinical parameters also significantly reduced: ESR (p<0.0001), CRP (p<0.02), VAS (p<0.001), number of total swollen joints (p<0.001), number of total painful joints (p<0.01), HAQ scores (p<0.05) and DAS 28 (p< 0.0001). A positive response to treatment with Etanercept was demonstrated both by US examination of several joints and by clinical evaluation of several parameters. US is a useful tool in the monitoring of biologic therapy in RA, assessing both inflammatory and destructive changes.

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Section: Resultsmentioning

confidence: 99%

“…It has enabled the exploration of various articular and peri-articular structures [24] together with local neovascularisation, thanks to power Doppler. It is now possible to identify and monitor the progression of active inflammation.…”

Section: Discussionmentioning

confidence: 99%

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

et al. 2007

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“…Binary grading 11 as well as a semiquantitative scoring system 9 were also developed for evaluating vascularization of synovial hypertrophy by CD/PD. Quantitative approaches are also utilized, including the determination of the number of Doppler pixels by dedicated pixel-counting software 12,13,14,15 , measurement of pulsatility and resistive indices, and microbubble contrast material.…”

Section: Journal Of Rheumatologymentioning

confidence: 99%

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

Mandl

Naredo²,

Wakefield³

et al. 2011

J Rheumatol

186

110

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Objective. The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of synovitis in RA, a systematic analysis of the literature was performed. Methods. A systematic literature search of Pubmecl and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of synovitis. Results. Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination. Conclusions. Ultrasound can be regarded as a valuable tool for globally examining the extent of synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed. (J Rheumatol 2011; 38:2055-62; doi:10.3899/jrheum.110424

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“…With regard to power Doppler signal, grade 0 was considered normal, while grades 1-3 were considered to be definitely pathologic (9). Each examination took ϳ15 minutes.…”

Section: Patientsmentioning

confidence: 99%

Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis

Szkudlarek¹,

Court‐Payen²,

Jacobsen³

et al. 2003

Arthritis & Rheumatism

Self Cite

671

447

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Objective. To evaluate the interobserver agreement of ultrasonographic assessment of finger and toe joints in patients with rheumatoid arthritis (RA) by 2 investigators with different medical backgrounds.Methods. Ultrasonography and clinical examination were performed on 150 small joints of 30 patients with active RA. A General Electric LOGIQ 500 ultrasound unit with a 7-13-MHz linear array transducer was used. In each patient, 5 preselected small joints (second and third metacarpophalangeal, second proximal interphalangeal, first and second metatarsophalangeal) were examined independently on the same day by 2 ultrasound investigators (an experienced musculoskeletal radiologist and a rheumatologist with limited ultrasound training). Joint effusion, synovial thickening, bone erosions, and power Doppler signal were evaluated in accordance with an introduced 4-grade semiquantitative scoring system, on which the investigators had reached consensus prior to the study.Results. Exact agreement between the 2 observers was seen in 91% of the examinations with regard to bone erosions, in 86% with regard to synovitis, in 79% with regard to joint effusions, and in 87% with regard to power Doppler signal assessments. Conclusion. An experienced radiologist and a rheumatologist with limited ultrasound training achieved high interobserver agreement rates for the identification of synovitis and bone erosions, using an introduced semiquantitative scoring system for ultrasonography of finger and toe joints in RA. Signs of inflammation were more frequently detected with ultrasound than with clinical examination. Ultrasonography may improve the assessment of RA patients by radiologists and rheumatologists.

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Power doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: A comparison with dynamic magnetic resonance imaging

Cited by 374 publications

References 23 publications

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

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

Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis

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