Furthermore, several US scoring systems, including reduced joint scores, have been developed to measure disease activity and therapeutic response, but they differ regarding the (number of) included joints and/or pathologic manifestations. Standardization of MSUS scanning techniques and definitions of pathologies are driven forward by the Outcome Measures in Rheumatology (OMERACT) ultrasound group and the European Alliance of associations for rheumatology (EULAR) recommendations and definitions including ultrasound synovitis and tenosynovitis scores on joint and tendon level. MSUS is therefore increasingly used in clinical practice and research. Furthermore, MSUS and MRI are more sensitive than clinical examination in detecting joint inflammation. Musculoskeletal ultrasound (MSUS) has proven to be a valid imaging method for the detection of inflammation (synovitis, tenosynovitis) and bony damage such as erosions with comparable sensitivity and specificity to magnetic resonance imaging (MRI). Ĭlinical and laboratory parameters as well as sensitive and reliable imaging modalities are utilized to ensure an early diagnosis and a rapid treatment initiation to prevent joint damage. Recent advances in the treatment for rheumatoid arthritis (RA) like conventional synthetic (cs), biological (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs), along with treating early and to target have significantly improved patients’ outcome. The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level. ![]() No major differences between the groups of early and established RA could be detected. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score’s information. palmar side of the wrist by GS/PD ( p < 0.001) and the palmar side of the finger joints by PD ( p < 0.001) were more frequently pathologic. The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43% MCP2: 35%/28% EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). ResultsĪ total of 435 patients ( N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). Analyses were also performed separately for early and established RA. The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score. ![]() Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet.
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