Abstract
ObjectiveTo assess if the right hand, the dominant hand, or the hand with more clinically swollen joints (SwJ) is per se the most inflamed and exhibits the greatest change during treatment and hence preferred for unilateral scoring of synovitis by ultrasound in rheumatoid arthritis (RA) patients.MethodsUsing data from two previously published Norwegian RA patient cohorts initiating treatment, bilateral metacarpophalangeal joint 1–5, proximal phalangeal joint 2+3, and wrists were evaluated by ultrasound. Using a 0–3 scoring system a grey-scale (GS), power Doppler (PD) and global synovitis score (GLOESS) was calculated for each hand (0–30). For precision, a difference of < ± 3 in sum score was pre-specified as indicating clinically insignificant difference in inflammatory activity for all three scores.ResultsFour hundred thirty-seven RA patients were included. Baseline ultrasound inflammation was statistically significantly higher in hands with more vs fewer SwJ ([mean difference, 95%CI] GS sum score 2.21[1.30 to 3.12], PD sum score 1.70 [0.94 to 2.47] and GLOESS 2.31[1.36 to 3.26]) and also exhibited significantly more change for all sum scores at 3 months follow-up (GS sum score 1.34 [0.60 to 2.08], PD sum score 1.17 [0.44 to 1.91], and GLOESS 1.43 [0.63 to 2.22]). No such differences were found between the dominant and the non-dominant or the right and the left hands at any time points.ConclusionThe hand with clinically more SwJ is statistically more inflammatory active according to GS, Doppler, and GLOESS sum scores, exhibits a change during treatment, and is potentially the best choice for unilateral scoring systems.
Highlights
Ultrasound has been validated as an outcome measurement tool for assessing synovitis by grey-scale (GS) and Doppler in rheumatoid arthritis (RA) [1, 2]
The hand with clinically more swollen joints (SwJ) is statistically more inflammatory active according to GS, Doppler, and GLOESS sum scores, exhibits a change during treatment, and is potentially the best choice for unilateral scoring systems
Baseline and follow-up demographics for the combined cohort as well as for the sub-cohorts are shown in and the ULRABIT cohort with 212 established RA patients with indication for biological DMARD (bDMARD)
Summary
Ultrasound has been validated as an outcome measurement tool for assessing synovitis by grey-scale (GS) and Doppler in rheumatoid arthritis (RA) [1, 2]. Ultrasound is used in clinical trials for assessing treatment response and remission. The components defining synovitis (synovial hypertrophy and hyperemia) are usually scored separately using a semi-quantitative scoring system OMERACT-EULAR combined scoring system [1], it is suggested to apply the highest score of the two components as the final score for the joint. Scoring GS synovial hypertrophy and Doppler activity separately or in combination is sensitive to change during treatment both on joint and patient level—for the latter using a sum score [6]. When applied in a clinical trial context, several reduced joint sets, ranging from 6 to 12 joints, have been proposed for scoring synovitis over the last years [7,8,9,10,11]
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