Relationship between clinical evaluation and ultrasound assessment of rheumatoid arthritis patients using a 12 joint score

• Published in: International journal of rheumatic diseases Vol. 20; no. 7; pp. 852 - 858
• Main Authors: Cerqueira, Marcos, Teixeira, Filipa, Sousa Neves, Joana, Peixoto, Daniela, Afonso, Maria Carmo, Costa, José A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.07.2017
• Subjects: Adult; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - physiopathology; disease activity; Female; Humans; Inflammation; Joint diseases; Joints - diagnostic imaging; Joints - physiopathology; Male; Middle Aged; Predictive Value of Tests; Rheumatoid arthritis; Severity of Illness Index; Synovitis; Synovitis - diagnostic imaging; Synovitis - physiopathology; Tenosynovitis; Tenosynovitis - diagnostic imaging; Tenosynovitis - physiopathology; Ultrasonic imaging; Ultrasonography, Doppler; Ultrasound; disease activity; rheumatoid arthritis; ultrasound
• ISSN: 1756-1841; 1756-185X
• DOI: 10.1111/1756-185X.13005

Aim To identify if the use of a systematic ultrasound (US) evaluation has relevance in the determination of disease activity in rheumatoid arthritis patients on biological disease‐modifying anti‐rheumatic drug treatment. Methods A 12 joint US assessment was performed on the same day of the routine clinical examination. Both Grey‐scale (GS) and Power Doppler (PD) were graded semi‐quantitatively (0–3 scale). Results Forty‐one patients were included. GS or PD > 0 were found in 24% and 3% of the ankles, 21% and 17% of the wrists, 19% and 9% of the second metacarpophalangeal joints (MCP), 7% and 2% of the third MCP, 6% and 0% of the knees and 5% and 0% of the elbows, respectively; tenosynovitis of the tibialis posterior was found in 19% of the ankles. Eight of the patients with Disease Activity Score of 28 joints (DAS28) ≤ 2.6 (n = 15) had an US score of 0. Twenty‐seven joints (6.7%) had US evidence of synovitis but were not considered to be swollen; 10 (2.5%) were considered to be swollen but had no US evidence of synovitis. Conclusions Using a 12 joint US assessment, a high proportion of patients with DAS28 < 2.6 were found to have inflammatory US activity, and a significant proportion of patients had evidence of tenosynovitis of the tibialis posterior, which may be difficult to clinically detect. A regular and standardized US assessment of RA patients is therefore warranted to complement clinical evaluation and better define disease activity.