title: Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44-joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent.
  
  
  METHODS
  A total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated.
  
  
  RESULTS
  A PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44-joint count and index for synovitis and PD signal and the 12-joint count and index for synovitis and PD signal at baseline and 6 months (r = 0.84-0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables.
  
  
  CONCLUSIONS
  A 12-joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.
authors.affiliation: Hospital Severo Ochoa, Madrid, Spain.
authors.forename: Esperanza
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authors.lastname: Naredo
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez
authors.forename: Cristina
authors.initials: C
authors.lastname: Campos
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rodríguez-Heredia
authors.forename: Julio A
authors.initials: JA
authors.lastname: Medina
authors.forename: Emilio
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authors.lastname: Giner
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authors.lastname: Martínez
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Toyos
authors.forename: Teresa
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authors.lastname: Ruíz
authors.forename: Inmaculada
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authors.lastname: Ros
authors.forename: Manuel
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authors.forename: Xavier
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authors.lastname: Miquel
authors.forename: Luz
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authors.lastname: García
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Aznar
authors.forename: Eugenio
authors.initials: E
authors.lastname: Chamizo
authors.forename: Manuel
authors.initials: M
authors.lastname: Páez
authors.forename: Pilar
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authors.lastname: Morales
authors.forename: Amalia
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authors.lastname: Rueda
authors.forename: Roser
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authors.lastname: Tuneu
authors.forename: Hector
authors.initials: H
authors.lastname: Corominas
authors.forename: Juan José
authors.initials: JJ
authors.lastname: de Agustín
authors.forename: Carmen
authors.initials: C
authors.lastname: Moragues
authors.forename: Dolores
authors.initials: D
authors.lastname: Mínguez
authors.forename: Alfredo
authors.initials: A
authors.lastname: Willisch
authors.forename: Isabel
authors.initials: I
authors.lastname: González-Cruz
authors.forename: Angel
authors.initials: A
authors.lastname: Aragón
authors.forename: Gerardo
authors.initials: G
authors.lastname: Iglesias
authors.forename: Carlos
authors.initials: C
authors.lastname: Armas
authors.forename: Juan
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authors.lastname: Pablo Valdazo
authors.forename: Carmen
authors.initials: C
authors.lastname: Vargas
authors.forename: Jaime
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authors.lastname: Calvo-Alén
authors.forename: Antonio
authors.initials: A
authors.lastname: Juan-Mas
authors.forename: Georgina
authors.initials: G
authors.lastname: Salvador
authors.forename: Angels
authors.initials: A
authors.lastname: Puigdollers
authors.forename: Eva
authors.initials: E
authors.lastname: Galíndez
authors.forename: Noemi
authors.initials: N
authors.lastname: Garrido
authors.forename: José
authors.initials: J
authors.lastname: Salaberri
authors.forename: Enrique
authors.initials: E
authors.lastname: Raya
authors.forename: Meritxell
authors.initials: M
authors.lastname: Salles
authors.forename: César
authors.initials: C
authors.lastname: Díaz
authors.forename: José Luis
authors.initials: JL
authors.lastname: Cuadra
authors.forename: Jesús
authors.initials: J
authors.lastname: Garrido
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000000981:diagnostic imaging; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler