Ultrasound composite scores for the assessment of inflammatory and structural pathologies in Psoriatic Arthritis (PsASon-Score)

Abstract

IntroductionThis study was performed to develop ultrasound composite scores for the assessment of inflammatory and structural lesions in Psoriatic Arthritis (PsA).MethodsWe performed a prospective study on 83 PsA patients undergoing two study visits scheduled 6 months apart. B-mode and Power Doppler (PD) findings were semi-quantitatively scored at 68 joints (evaluating synovia, perisynovial tissue, tendons and bone) and 14 entheses. We constructed bilateral and unilateral (focusing the dominant site) ultrasound composite scores selecting relevant sites by a hierarchical approach. We tested convergent construct validity, reliability and feasibility of inflammatory and structural elements of the scores as well as sensitivity to change for inflammatory items.ResultsThe bilateral score (termed PsASon22) included 22 joints (6 metacarpophalangeal joints (MCPs), 4 proximal interphalangeal joints (PIPs) of hands (H-PIPs), 2 metatarsophalangeal joints (MTPs), 4 distal interphalangeal joints (DIPs) of hands (H-DIPs), 2 DIPs of feet (F-DIPs), 4 large joints) and 4 entheses (bilateral assessment of lateral epicondyle and distal patellar tendon). The unilateral score (PsASon13) compromised 13 joints (2 MCPs, 3 H-PIPs, 1 PIP of feet (F-PIP), 2 MTPs, 1 H-DIP and 2 F-DIPs and 2 large joints) and 2 entheses (unilateral lateral epicondyle and distal patellar tendon). Both composite scores revealed a moderate to high sensitivity (bilateral composite score 43% to 100%, unilateral 36% to 100%) to detect inflammatory and structural lesions compared to the 68-joint/14-entheses score. The inflammatory and structural components of the composite scores correlated weakly with clinical markers of disease activity (corrcoeffs 0 to 0.40) and the health assessment questionnaire (HAQ, corrcoeffs 0 to 0.39), respectively. Patients with active disease achieving remission at follow-up yielded greater reductions of ultrasound inflammatory scores than those with stable clinical activity (Cohen’s d effect size ranging from 0 to 0.79). Inter-rater reliability of bi- and unilateral composite scores was moderate to good with ICCs ranging from 0.42 to 0.96 and from 0.36 to 0.71, respectively for inflammatory and structural sub-scores. The PsASon22 and PsASon13 required 16 to 26 and 9 to 13 minutes, respectively to be completed.ConclusionBoth new PsA ultrasound composite scores (PsASon22 and PsASon13) revealed sufficient convergent construct validity, sensitivity to change, reliability and feasibility.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-014-0476-2) contains supplementary material, which is available to authorized users.

Knee ultrasound from research to real practice: a systematic literature review of adult knee ultrasound assessment feasibility studies.

“…However, we decided to score this area of focus with one point, while we gave no points for the Adaptation domain, even though the authors tackled this area by recommending further studies including more joints. Notwithstanding the low score this paper obtained (less than half of the maximum score and equal to the one given to other 5 different articles [11,12,15,[17][18]), it is the only one of the publications we selected that took into account a wider range of feasibility aspects, closer to the way we envisage a MSUS feasibility study should be conducted. Moreover, the points given to the papers based on the study of US scores, were assigned mainly due to some overlap between two of the domain's outcomes of interest (inter-rater and intra-rater reliability, score sensitivity to change and assessment duration could represent outcomes of interest to both Implementation and Practicality) and the fact that we considered the US score testing itself as addressing the Demand domain.…”

“…Six out of the nine analysed studies focused on validating US scores and quantified feasibility as time spent for the US examination, disregarding any other feasibility related aspects [11,12,[15][16][17][18]. In one of the studies, the main objective was to investigate the feasibility of US guided knee intra-articular injections [14], but in the results section the authors refer to feasibility exclusively as the accuracy of the technique.…”

“…The results of the semi-quantitative evaluation of the selected papers, as detailed in the Methods section above, are as follows: the highest score (3) was obtained by 6 of the papers [10][11][12]15,17,18], while two publications scored one point each [13,16] and one received 2 points [14]. Based on the set of focus areas previously mentioned, none of the works included in the final analysis practiced a systematic assessment of all feasibility domains, acquiring less than half of the maximum score we proposed.…”

“…The study that investigated the possibility of introducing MSUS in internal medicine residency [10] took into consideration aspects such as residents' training, cognitive skill set and competence evaluation, attending perception of the trainers and trainees (aspects pertaining to the implementation and practicality domains), but failed to consider any other feasibility area. Only 5 of the studies offered details regarding the equipment used and its technical characteristics [12][13][14][15]18], while almost all included an ample description of the assessed joints and features or structures [11][12][13][14][15][16]18].…”

Could nail and joint alterations make the difference between psoriatic arthritis and osteoarthritis during the ultrasonographic evaluation of the distal interphalangeal joints?

“…As a consequence of persistent inflammation, bone erosions and new bone formation can be seen at these sites. In addition, articular involvement can be present, with synovitis and effusion which are detectable by B-mode and Doppler modalities [6]. Patients with PsA showed significantly more pathological findings at the DIP, compared to RA.…”