Abstract
IntroductionThe primary objectives were to explore the associations between a comprehensive ultrasonographic (US) assessment of joints, tendons and bursae and previously described reduced joint counts (7-, 12-, 28- and 44-joint score) as well as to assess the sensitivity to change of these different US joint combinations during biological treatment.MethodsTwenty patients with rheumatoid arthritis (RA) were examined by US (B-mode (BM) and power Doppler (PD)) with use of a semi-quantitative (0 to 3) score of 78 joints, 36 tendons/tendon groups and two bursae (hereafter described as the 78-joint score) at baseline and 1, 3, 6 and 12 months after initiating treatment with adalimumab. BM and PD scores for the different joint combinations were generated.ResultsThe reduced joint scores had high correlation coefficients with the 78-joint score at all examinations (range 0.79 to 0.99 for BM and 0.77 to 0.99 for PD, each P < 0.001) and sum BM and PD scores of all the different joint combinations improved significantly during follow-up (P ≤ 0.05 to 0.001).ConclusionsThe reduced joint combinations were highly associated to the 78-joint score. Furthermore, all the joint combinations presently explored responded well to biological treatment. This indicates that an approach focusing on few joints and tendons gives equivalent information about the inflammatory activity in RA patients as a comprehensive US examination. The optimal combination of joints and tendons for a valid, reliable and feasible US measurement should be further explored to define a US score for follow-up of RA patients on biological treatment.
Highlights
The primary objectives were to explore the associations between a comprehensive ultrasonographic (US) assessment of joints, tendons and bursae and previously described reduced joint counts (7, 12, 28- and 44joint score) as well as to assess the sensitivity to change of these different US joint combinations during biological treatment
Tenosynovitis is a frequent pathology in rheumatoid arthritis (RA) patients and both US and Magnetic Resonance Imaging (MRI) assessments have been shown to be responsive [15,16] and evaluation of tenosynovitis may be considered for inclusion in an optimal US score
High correlations were found between the sum BM 78-joint score and all of the different joint combinations, with median correlation coefficients at the five examinations of 0.89 (0.86 to 0.96) for BM 7-joint score, 0.86 (0.79 to 0.96) for BM 12-joint score, 0.95 (0.92 to 0.97) for BM 28-joint score and 0.97 (0.95 to 0.99) for BM 44-joint score
Summary
The primary objectives were to explore the associations between a comprehensive ultrasonographic (US) assessment of joints, tendons and bursae and previously described reduced joint counts (7-, 12-, 28- and 44joint score) as well as to assess the sensitivity to change of these different US joint combinations during biological treatment. The. 7-joint score by Backhaus et al [9] was evaluated in a longitudinal multicenter German study and found to reflect disease activity and therapeutic response. Naredo et al [10] developed from a 44-joint score in a multicenter Spanish study a 12-joint score that was useful in monitoring the response to biological medications. Another 44-joint score was used by Scirè et al [11] and a 28-joint US score assessing the joints included in the composite DAS28 score [12] has been used in longitudinal and cross-sectional studies [3,5,13]. Tenosynovitis is a frequent pathology in RA patients and both US and MRI assessments have been shown to be responsive [15,16] and evaluation of tenosynovitis may be considered for inclusion in an optimal US score
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