RESEARCH - A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in RA

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Arthritis Rheum. 2005 Mar;52(3):733-43.

A novel ultrasonographic synovitis scoring system suitable for analyzing

finger joint inflammation in rheumatoid arthritis.

Scheel AK, Hermann KG, Kahler E, Pasewaldt D, Fritz J, Hamm B, Brunner E,

Muller GA, Burmester GR, Backhaus M.

Georg-August-University Gottingen, Gottingen, Germany.

OBJECTIVE: To develop an ultrasonographic (US) synovitis scoring system

suitable for evaluation of finger joint inflammation in patients with active

rheumatoid arthritis (RA) and to compare semiquantitative US scoring with

quantitative US measurements. METHODS: US was performed at the palmar and

dorsal sides of the second through fifth metacarpophalangeal (MCP) and

proximal interphalangeal (PIP) joints in 10 healthy subjects and in the

clinically more affected hand in 46 RA patients. Ten patients additionally

underwent magnetic resonance imaging (MRI). Synovitis was measured,

standardized, and scored according to a semiquantitative method. The 2

methods (semiquantitative US scoring, quantitative US) were compared and

statistical cutoffs were identified using receiver operating characteristic

(ROC) curve analysis. MRI results were compared with semiquantitative US

scoring and quantitative US results. The optimal US scoring method from 6

joint combinations was identified (ROC curve analysis). RESULTS: Synovitis

was most frequently detected in the palmar proximal area (86% of affected

joints). We found no significant differences between individual PIP joints

or between individual MCP joints, indicating that all fingers within each of

these joint groups should be treated equally for statistical calculations,

although each joint group as a whole should be treated separately. The

optimal cutoff point to distinguish between " health " and " pathology " was 0.6

mm both for MCP joints (sensitivity 94%, specificity 89%) and for PIP joints

(sensitivity 90%, specificity 88%). There was no significant difference

between semiquantitative US scores and quantitative US measurements. The

best results for joint combinations were achieved using the " sum of 4

fingers " (second through fifth MCP and PIP joints) and " sum of 3 fingers "

(second through fourth MCP and PIP joints) methods. Comparison of MRI

results with semiquantitative US scores revealed high concordance.

CONCLUSION: US evaluation of finger joint synovitis can be considerably

simplified by focusing on the palmar side and by applying semiquantitative

grading instead of quantitative measurements. For evaluation of treatment

efficacy based on synovitis in RA patients, we recommend using the " sum of 3

fingers " method in longitudinal trials.

PMID: 15751062

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5751062 & dopt=Abstract

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