Contributions of ultrasound beyond clinical data in assessing inflammatory disease activity in rheumatoid arthritis: current insights and future prospects.
Appropriate measures of disease activity need to be valid, reliable and sensitive to change for use in clinical studies while remaining at the same time feasible and practicable for utilization in daily clinical practice. Ultrasonography was shown to be a valid, sensitive and reliable imaging modality for the detection of synovitis in RA, however, it has so far failed to demonstrate superior sensitivity to change as compared with clinical examination. This review examines the current evidence for the use of established measures and/or US, either as an alternative or as a supplementary measure to clinical examination, as tools for monitoring synovitis in RA. It also includes a summary of results of recent studies evaluating clinical examination-based as well as clinical- and US-based multimodal disease activity indices. We review the rationale and limitations of incorporating US into composite disease activity indices and suggest a research roadmap for further studies in this field.
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria. peter.mandl@meduniwien.ac.at.
Peter
P
Mandl
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
Reka
R
Kurucz
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
Dora
D
Niedermayer
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
Peter V
PV
Balint
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria. Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria.
Josef S
JS
Smolen
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography / Q000379:methods
clinical evaluation; disease activity indices; rheumatoid arthritis; ultrasound