Objective. The main objective of this study was to evaluate the 7-joint ultrasound (US7) score by detailed joint region analysis of an arthritis patient cohort. Methods. The US7 score examines the clinically most affected wrist, MCP and PIP II, III, MTP II, and V joints for synovitis, tenosynovitis/paratenonitis, and erosions. Forty-five patients with rheumatoid arthritis (RA) (84.4%) and spondyloarthritis with polyarticular peripheral arthritis (PsA 13.3%; AS 2.2%) with a median disease duration of 6.5？yrs (range 7.5？mths–47.6？yrs) were included and examined at baseline and 3, 6, and 12 months after starting or changing therapy (DMARD/biologic). In this study, detailed US7 score joint region analysis was firstly performed. Results. The joint region analysis performed at baseline disclosed synovitis in 95.6% of affected wrists in the dorsal aspect by greyscale (GS) US where Grade 2 (moderate) was most often (48.9%) detected. Palmar wrist regions presented Grade 1 (minor) capsule elevation in 40% and Grade 2 (moderate synovitis) in 37.8%. Tenosynovitis of the extensor carpi ulnaris (ECU) tendon was found in 40%, with PD activity in 6.6%. Most of the erosions in MCP II were detected in the radial (68.9%), followed by the dorsal (48.9%) and palmar (44.4%) aspects. In MTP V, erosions were seen in 75.6% from lateral. Conclusions. Synovitis in GSUS was more often detected in the wrist in the dorsal than in the palmar aspect. ECU tendon involvement was frequent. Most erosions were found in the lateral scan of MTP V and the medial (radial) scan of MCP II. 1. Introduction Objective imaging modalities are needed to detect the inflammatory and destructive processes in arthritic diseases such as rheumatoid arthritis (RA) and seronegative spondyloarthritis (e.g., psoriatic arthritis). In recent years, there have been numerous studies reporting early detection of soft tissue and bone processes in arthritic diseases and a high level of sensitivity in musculoskeletal ultrasonography (US) [1–8]. This imaging method allows disease activity and therapeutic response to be detected objectively and for immunosuppressive therapy to be adapted accordingly. As a result, better rheumatic disease outcomes might be achieved and structural damage prevented at earlier stages [9–13]. Due to rapid technical improvements, US has become the “extended diagnostic finger” in the rheumatologist’s daily practice with high patient acceptability. Therefore, accurate assessment of joint inflammation such as synovitis and bone processes is extremely important and standardization is, therefore,
References
[1]
M. Backhaus, T. Kamradt, D. Sandrock et al., “Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging,” Arthritis and Rheumatism, vol. 42, no. 6, pp. 1232–1245, 1999.
[2]
R. J. Wakefield, W. W. Gibbon, P. G. Conaghan et al., “The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography,” Arthritis and Rheumatism, vol. 43, no. 12, pp. 2762–2770, 2000.
[3]
M. Backhaus, G. R. Burmester, D. Sandrock et al., “Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints,” Annals of the Rheumatic Diseases, vol. 61, no. 10, pp. 895–904, 2002.
[4]
M. Szkudlarek, E. Narvestad, M. Klarlund, M. Court-Payen, H. S. Thomsen, and M. ？stergaard, “Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination,” Arthritis and Rheumatism, vol. 50, no. 7, pp. 2103–2112, 2004.
[5]
A. K. Scheel, K. G. A. Hermann, S. Ohrndorf et al., “Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints,” Annals of the Rheumatic Diseases, vol. 65, no. 5, pp. 595–600, 2006.
[6]
N. J. McHugh, C. Balachrishnan, and S. M. Jones, “Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study,” Rheumatology, vol. 42, no. 6, pp. 778–783, 2003.
[7]
D. Kane, “The role of ultrasound in the diagnosis and management of psoriatic arthritis,” Current Rheumatology Reports, vol. 7, no. 4, pp. 319–324, 2005.
[8]
A. L. Tan and D. McGonagle, “Psoriatic arthritis: correlation between imaging and pathology,” Joint Bone Spine, vol. 77, no. 3, pp. 206–211, 2010.
[9]
R. Maini, E. W. St Clair, F. Breedveld et al., “Infliximab (chimeric anti-tumour necrosis factor α monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial,” The Lancet, vol. 354, no. 9194, pp. 1932–1939, 1999.
[10]
J. S. Smolen, C. Han, M. Bala et al., “Evidence of radiographic benefit of treatment with infliximab plus methotrexate in rheumatoid arthritis patients who had no clinical improvement: a detailed subanalysis of data from the anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study,” Arthritis and Rheumatism, vol. 52, no. 4, pp. 1020–1030, 2005.
[11]
F. C. Breedveld, M. H. Weisman, A. F. Kavanaugh et al., “The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment,” Arthritis and Rheumatism, vol. 54, no. 1, pp. 26–37, 2006.
[12]
D. van der Heijde, L. Klareskog, V. Rodriguez-Valverde et al., “Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial,” Arthritis and Rheumatism, vol. 54, no. 4, pp. 1063–1074, 2006.
[13]
R. Landewé, D. van der Heijde, L. Klareskog, R. van Vollenhoven, and S. Fatenejad, “Disconnect between inflammation and joint destruction after treatment with etanercept plus methotrexate: results from the trial of etanercept and methotrexate with radiographic and patient outcomes,” Arthritis and Rheumatism, vol. 54, no. 10, pp. 3119–3125, 2006.
[14]
M. Backhaus, S. Ohrndorf, H. Kellner et al., “Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project,” Arthritis Care and Research, vol. 61, no. 9, pp. 1194–1201, 2009.
[15]
T. M. Backhaus, S. Ohrndorf, H. Kellner et al., “The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy,” Annals of the Rheumatic Diseases, vol. 72, no. 7, pp. 1163–1169, 2013.
[16]
M. Backhaus, G. R. Burmester, T. Gerber et al., “Guidelines for musculoskeletal ultrasound in rheumatology,” Annals of the Rheumatic Diseases, vol. 60, no. 7, pp. 641–649, 2001.
[17]
R. J. Wakefield, P. V. Balint, M. Szkudlarek, and G. A. W. Bruyn, “Musculoskeletal ultrasound including definitions for ultrasonographic pathology,” Journal of Rheumatology, vol. 32, no. 12, pp. 2485–2487, 2005.
[18]
M. Szkudlarek, M. Court-Payen, S. Jacobsen, M. Klarlund, H. S. Thomsen, and M. ？stergaard, “Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis,” Arthritis and Rheumatism, vol. 48, no. 4, pp. 955–962, 2003.
[19]
A. K. Scheel, K. A. Hermann, E. Kahler et al., “A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis,” Arthritis and Rheumatism, vol. 52, no. 3, pp. 733–743, 2005.
[20]
O. Steinbrocker, C. H. Traeger, and R. C. Batterman, “Therapeutic criteria in rheumatoid arthritis,” The Journal of the American Medical Association, vol. 140, no. 8, pp. 659–662, 1949.
[21]
K. Ellegaard, S. Torp-Pedersen, L. Terslev, B. Danneskiold-Sams？e, M. Henriksen, and H. Bliddal, “Ultrasound colour Doppler measurements in a single joint as measure of disease activity in patients with rheumatoid arthritis—assessment of concurrent validity,” Rheumatology, vol. 48, no. 3, pp. 254–257, 2009.
[22]
V. Vlad, F. Berghea, S. Libianu et al., “Ultrasound in rheumatoid arthritis—volar versus dorsal synovitis evaluation and scoring,” BMC Musculoskeletal Disorders, vol. 12, article 124, 2011.
[23]
M. Dougados, S. Jousse-Joulin, F. Mistretta et al., “Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: results from a prospective multicentre study of rheumatoid arthritis,” Annals of the Rheumatic Diseases, vol. 69, no. 5, pp. 828–833, 2010.
[24]
J. Sommier, S. Michel-Batot, N. Sauliere, et al., “Structural lesions in RA: proposition for a new semiquantitative score (ScUSSe: Scoring by UltraSound Structural erosion),” Arthritis and Rheumatism, vol. 54, supplement 209, 2006.
[25]
S. Lillegraven, P. B？yesen, H. B. Hammer et al., “Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis,” Annals of the Rheumatic Diseases, vol. 70, no. 11, pp. 2049–2050, 2011.
[26]
R. Rau, S. Wassenberg, G. Herborn, W. T. Perschel, and G. Freitag, “Identification of radiologic healing phenomena in patients with rheumatoid arthritis,” Journal of Rheumatology, vol. 28, no. 12, pp. 2608–2615, 2001.
[27]
R. Rau, G. Herborn, and S. Wasenberg, “Healing of erosive changes in rheumatoid arthritis,” Clinical and Experimental Rheumatology, vol. 22, no. 5, supplement 35, pp. S44–S49, 2004.
[28]
S. Finzel, J. Rech, S. Schmidt et al., “Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion,” Annals of the Rheumatic Diseases, vol. 70, no. 9, pp. 1587–1593, 2011.
[29]
S. Ohrndorf, I. U. Fischer, H. Kellner et al., “Reliability of the novel 7-joint ultrasound score (US7): results from an inter- and intra-observer study performed by rheumatologists,” Arthritis Care and Research, vol. 64, no. 8, pp. 1238–1243, 2012.
[30]
U. M. D？hn, B. J. Ejbjerg, M. Court-Payen et al., “Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints,” Arthritis Research and Therapy, vol. 8, no. 4, article R110, 2006.
