A Novel Simplified Ultrasound Scoring System for Evaluation of Activity in Rheumatoid Arthritis Patients

Abstract

To find a simplified and effective ultrasound scoring system for evaluation of activity in rheumatoid arthritis(RA) patients. Bilateral joints of elbow(Elb), wrist(Wri), metacarpophalangeal(MCP) 1-5, proximal interphalangeal(PIP) 1-5,knee(Kne), ankle(Ank) and metatarsophalangeal(MTP) 1-5 of 141 RA patients were examined by high frequency ultrasound. The appearances of synovitis, power Doppler(PD) signal, effusion, and bone erosion were scored semi quantitatively(scores 0-3) respectively. Twenty eight joints Disease Activity Scores (DAS28) were calculated. Relationships among DAS 28 and synovitis, PD, effusion, and bone erosion scores were analysed. The sum scores of all investigated joints of synovitis, PD and effusion were correlated significantly(p < 0.01) with DAS28 respectively. The sum scores of bone erosion were notcorrelated with DAS28(P >0.05). The sum scores of synovitis of bilateral Wri 、Elb 、Kne 、 MCP2 、MTP1、PIP3、MTP4 and PIP1 were significantly correlated with DAS28(r=0.484, p<0.01) mostly. The sum scores of PD of bilateral Wri 、MTP1 、Kne 、PIP3 and MCP3 were significantly correlated with DAS28(r=0.371, p<0.01) mostly. The sum scores of effusion of bilateral Kne、MCP3 、MTP4 、MCP4 、MCP5 、MTP5 、PIP4 、PIP5 、MCP1 、PIP3 、MTP3 and Ank were significantly correlated with DAS28(r=0.531, p<0.01) mostly. In combination, the total scores of synovitis plus PD plus effusion of Kne 、Wri 、Elb 、MTP4 、MCP3 、MCP4 、 PIP3 、MTP5 、PIP1 、PIP4 were significantly correlated with DAS28(r=0.584, p<0.01) mostly. The total scores of Kne 、Wri 、Elb 、MTP4 、MCP3were also significantly correlated with DAS28(r=0.559, p<0.01), and the r value was just lower mildly than that of previous 10 joints(0.559 vs 0.584). The sum scores of synovitis, PD and effusion were all correlated with DAS28, and can reflect disease activity of RA, whereas bone erosion cannot. The total scores of Kne、Wri、 Elb、MTP4、MCP3 joints can simply and effectively evaluate disease activity of RA.