title: Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the clinical relevance of grade 1 findings on gray-scale ultrasound (GSUS) of the joints in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  We examined the wrists and small joints of 100 patients with early or established RA and 30 healthy controls, using GSUS and power Doppler ultrasound (PDUS). Independent clinical assessment of all joints for tenderness and swelling according to the European League Against Rheumatism examination technique was performed. Joints with grade 1 findings on GSUS were identified, and associations with swelling, pain, and findings on PDUS were assessed. Grade 1 findings on GSUS in patients with early RA were reassessed after 6 months of antirheumatic treatment.
  
  
  RESULTS
  Grade 1 results represented the majority of all GSUS findings in patients with RA and were also frequently recorded in healthy controls. Grade 1 GSUS findings were not associated with tenderness, swelling, or positive results on PDUS. In comparison to joints with grade 2 and grade 3 findings on GSUS, joints with grade 1 findings were less likely to respond to treatment.
  
  
  CONCLUSIONS
  The present results indicate that grade 1 findings on GSUS have limited clinical relevance.
authors.affiliation: University of Munich, Munich, Germany. matthias.witt@med.uni-muenchen.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Witt
authors.forename: Felix
authors.initials: F
authors.lastname: Mueller
authors.forename: Axel
authors.initials: A
authors.lastname: Nigg
authors.forename: Christiane
authors.initials: C
authors.lastname: Reindl
authors.forename: Jan
authors.initials: J
authors.lastname: Leipe
authors.forename: Fabian
authors.initials: F
authors.lastname: Proft
authors.forename: Nicola
authors.initials: N
authors.lastname: Stein
authors.forename: Ariane
authors.initials: A
authors.lastname: Hammitzsch
authors.forename: Stefan
authors.initials: S
authors.lastname: Mayer
authors.forename: Claudia
authors.initials: C
authors.lastname: Dechant
authors.forename: Hendrik
authors.initials: H
authors.lastname: Schulze-Koops
authors.forename: Mathias
authors.initials: M
authors.lastname: Grunke
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010808:Physical Examination; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography; D014955:Wrist Joint / Q000000981:diagnostic imaging
chemical_list: D002097:C-Reactive Protein