Simplified Ultrasonography Scores For Assessment Of Activity In Rheumatoid Arthritis

Objective To investigate the validity of a simplified ultrasonography scores assessment of joint inflammatory activity in patients with rheumatoid arthritis(RA).Methods One hundred and forty one patients with RA were included.The patients underwent Disease Activity Score 28 joints(DAS-28) assessment. The ultrasound scores included the following bilateral joints: elbow, wrist, metacarpophalangeal, knee, ankle and metatarsophalangeal joints.Synovitis, joint effusion, PD signal and bone erosion were scored semiquantitatively(grade 0-3) by gray-scale US and power Doppler US. US count and index for synovitis,joint effusion,PD signal and bone erosion were obtained. Relationship between sum synovitis scores,sum joint effusion scores, sum PD signal scores,sum bone erosion scores, sum US scores,different joint combinations of US scores and DAS-28 were analysised.Results There was a significant relation between the DAS-28 and the sum synovitis scores(r=0.415,p<0.01) and sum joint effusion scores(r=0.483,p<0.01) and sum PD signal scores(r=0.329,p<0.01)and sum US scores(r=0.518,p<0.01);The US measures of bone erosion related poorly to DAS28;The highest correlation between DAS-28 scores and different joint combinations synovitis scores was a 8-joint score which included bilateral Wri, Elb, Kne, MCP2, MTP1, PIP3, MTP4, PIP1(r=0.484,p<0.01) and different joint combinations PD signal scores was a 5-joint score which included bilateral Wri,MTP1,Kne,PIP3,MCP3(r=0.371,p<0.01) and different joint combinations joint effusion scores was a 12-joint score which included bilateral Kne,MCP3,MTP4,MCP4,MCP5,MTP5,PIP4,PIP5,MCP1,PIP3, MTP3, Ank(r=0.531,p<0.01). A composite US scores which contained synovitis scores of bilateral Wri, Elb, Kne, MCP2, MTP1, PIP3, MTP4, PIP1 and PD signal scores of bilateral Wri, MTP1, Kne, PIP3, MCP3 and joint effusion scores of bilateral Kne,MCP3,MTP4,MCP4,MCP5,MTP5,PIP4,PIP5,MCP1,PIP3,MTP3, Ank correlated with DAS28(r=0.561,p<0.01). The highest correlationbetween DAS-28 scores and different joint combinations US scores was a 10-joint score which included bilateral Kne, Wri, Elb, MTP4, MCP3, MCP4, PIP3, MTP5, PIP1, PIP4(r=0.584,p<0.01). The simplified ultrasonography scores assessment of joint inflammatory activity in patients with RA was A 5-joint US scores which included bilateral Kne, Wri, Elb, MTP4, MCP3.Conclusion 1. The sum synovitis scores,sum joint effusion scores,sum PD signal scores and sum US scores had high correlation with DAS-28,the US measures of bone erosion had no correlation with DAS28; 2. The highest correlation between DAS-28 scores and different joint combinations US scores was a 10-joint score which included bilateral Kne, Wri, Elb, MTP4, MCP3, MCP4, PIP3, MTP5, PIP1, PIP4;3. A 5-joint US scores which including bilateral Kne,Wri,Elb,MTP4,MCP3 may be a valid, fessible method for evaluation of activity in RA.