Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: results from a prospective multicentre study of rheumatoid arthritis.
OBJECTIVE
To evaluate different global ultrasonographic (US) synovitis scoring systems as potential outcome measures of rheumatoid arthritis (RA) according to the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) filter.


METHODS
To study selected global scoring systems, for the clinical, B mode and power Doppler techniques, the following joints were evaluated: 28 joints (28-joint Disease Activity Score (DAS28)), 20 joints (metacarpophalangeals (MCPs) + metatarsophalangeals (MTPs)) and 38 joints (28 joints + MTPs) using either a binary (yes/no) or a 0-3 grade. The study was a prospective, 4-month duration follow-up of 76 patients with RA requiring anti-tumour necrosis factor (TNF) therapy (complete follow-up data: 66 patients). Intraobserver reliability was evaluated using the intraclass correlation coefficient (ICC), construct validity was evaluated using the Cronbach alpha test and external validity was evaluated using level of correlation between scoring system and C reactive protein (CRP). Sensitivity to change was evaluated using the standardised response mean. Discriminating capacity was evaluated using the standardised mean differences in patients considered by the doctor as significantly improved or not at the end of the study.


RESULTS
Different clinimetric properties of various US scoring systems were at least as good as the clinical scores with, for example, intraobserver reliability ranging from 0.61 to 0.97 versus from 0.53 to 0.82, construct validity ranging from 0.76 to 0.89 versus from 0.76 to 0.88, correlation with CRP ranging from 0.28 to 0.34 versus from 0.28 to 0.35 and sensitivity to change ranging from 0.60 to 1.21 versus from 0.96 to 1.36 for US versus clinical scoring systems, respectively.


CONCLUSIONS
This study suggests that US evaluation of synovitis is an outcome measure at least as relevant as physical examination. Further studies are required in order to achieve optimal US scoring systems for monitoring patients with RA in clinical trials and in clinical practice.
Dougados
Maxime
M
Medicine Faculty, Rheumatology B Department, Descartes University; UPRES-EA 4058; APHP, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France. m.doug@cch.aphp.fr
Jousse-Joulin
Sandrine
S
Mistretta
Frederic
F
d'Agostino
Maria-Antonietta
MA
Backhaus
Marina
M
Bentin
Jacques
J
Chalès
Gérard
G
Chary-Valckenaere
Isabelle
I
Conaghan
Philip
P
Etchepare
Fabien
F
Gaudin
Philippe
P
Grassi
Walter
W
van der Heijde
Désirée
D
Sellam
Jérémie
J
Naredo
Esperanza
E
Szkudlarek
Marcin
M
Wakefield
Richard
R
Saraux
Alain
A
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination / Q000379:methods; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D018608:Ultrasonography, Doppler / Q000379:methods
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha