RESEARCH - Evaluation of a novel 7-joint ultrasound scroe in daily rheumatologic practice: a pilot project

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Arthritis Rheum. 2009 Sep 15;61(9):1194-201.

Evaluation of a novel 7-joint ultrasound score in daily rheumatologic

practice: a pilot project.

Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W,

Sattler H, Albrecht K, Kaufmann J, Becker K, Sörensen H, Meier L,

Burmester GR, Schmidt WA.

Charité-University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany.

OBJECTIVE: To introduce a new standardized ultrasound score based on 7

joints of the clinically dominant hand and foot (German US7 score)

implemented in daily rheumatologic practice.

METHODS: The ultrasound score included the following joints of the

clinically dominant hand and foot: wrist, second and third

metacarpophalangeal and proximal interphalangeal, and second and fifth

metatarsophalangeal joints. Synovitis and synovial/tenosynovial

vascularity were scored semiquantitatively (grade 0-3) by gray-scale

(GS) and power Doppler (PD) ultrasound. Tenosynovitis and erosions

were scored for presence. The scoring range was 0-27 for GS synovitis,

0-39 for PD synovitis, 0-7 for GS tenosynovitis, 0-21 for PD

tenosynovitis, and 0-14 for erosions. Patients with arthritis were

examined at baseline and after the start or change of

disease-modifying antirheumatic drug (DMARD) and/or tumor necrosis

factor alpha (TNFalpha) inhibitor therapy 3 and 6 months later.

C-reactive protein level, erythrocyte sedimentation rate, rheumatoid

factor, anti-cyclic citrullinated peptide, Disease Activity Score in

28 joints (DAS28), and radiographs of the hands and feet were

performed.

RESULTS: One hundred twenty patients (76% women) with rheumatoid

arthritis (91%) and psoriatic arthritis (9%) were enrolled. In 52

cases (43%), erosions were seen in radiography at baseline. Patients

received DMARDs (41%), DMARDs plus TNFalpha inhibitors (41%), or

TNFalpha inhibitor monotherapy (18%). At baseline, the mean DAS28 was

5.0 and the synovitis scores were 8.1 in GS ultrasound and 3.3 in PD

ultrasound. After 6 months of therapy, the DAS28 significantly

decreased to 3.6 (Delta = 1.4), and the GS and PD ultrasound scores

significantly decreased to 5.5 (-32%) and 2.0 (-39%), respectively.

CONCLUSION: The German US7 score is a viable tool for examining

patients with arthritis in daily rheumatologic practice because it

significantly reflects therapeutic response.

PMID: 19714611

http://www.ncbi.nlm.nih.gov/pubmed/19714611

Not an MD