title: Ultrasound composite scores for the assessment of inflammatory and structural pathologies in Psoriatic Arthritis (PsASon-Score).
abstract: BACKGROUND
  This study was performed to develop ultrasound composite scores for the assessment of inflammatory and structural lesions in Psoriatic Arthritis (PsA).
  
  
  METHODS
  We performed a prospective study on 83 PsA patients undergoing two study visits scheduled 6 months apart. B-mode and Power Doppler (PD) findings were semi-quantitatively scored at 68 joints (evaluating synovia, perisynovial tissue, tendons and bone) and 14 entheses. We constructed bilateral and unilateral (focusing the dominant site) ultrasound composite scores selecting relevant sites by a hierarchical approach. We tested convergent construct validity, reliability and feasibility of inflammatory and structural elements of the scores as well as sensitivity to change for inflammatory items.
  
  
  RESULTS
  The bilateral score (termed PsASon22) included 22 joints (6 metacarpophalangeal joints (MCPs), 4 proximal interphalangeal joints (PIPs) of hands (H-PIPs), 2 metatarsophalangeal joints (MTPs), 4 distal interphalangeal joints (DIPs) of hands (H-DIPs), 2 DIPs of feet (F-DIPs), 4 large joints) and 4 entheses (bilateral assessment of lateral epicondyle and distal patellar tendon). The unilateral score (PsASon13) compromised 13 joints (2 MCPs, 3 H-PIPs, 1 PIP of feet (F-PIP), 2 MTPs, 1 H-DIP and 2 F-DIPs and 2 large joints) and 2 entheses (unilateral lateral epicondyle and distal patellar tendon). Both composite scores revealed a moderate to high sensitivity (bilateral composite score 43% to 100%, unilateral 36% to 100%) to detect inflammatory and structural lesions compared to the 68-joint/14-entheses score. The inflammatory and structural components of the composite scores correlated weakly with clinical markers of disease activity (corrcoeffs 0 to 0.40) and the health assessment questionnaire (HAQ, corrcoeffs 0 to 0.39), respectively. Patients with active disease achieving remission at follow-up yielded greater reductions of ultrasound inflammatory scores than those with stable clinical activity (Cohen's d effect size ranging from 0 to 0.79). Inter-rater reliability of bi- and unilateral composite scores was moderate to good with ICCs ranging from 0.42 to 0.96 and from 0.36 to 0.71, respectively for inflammatory and structural sub-scores. The PsASon22 and PsASon13 required 16 to 26 and 9 to 13 minutes, respectively to be completed.
  
  
  CONCLUSIONS
  Both new PsA ultrasound composite scores (PsASon22 and PsASon13) revealed sufficient convergent construct validity, sensitivity to change, reliability and feasibility.
authors.forename: Anja
authors.initials: A
authors.lastname: Ficjan
authors.forename: Rusmir
authors.initials: R
authors.lastname: Husic
authors.forename: Judith
authors.initials: J
authors.lastname: Gretler
authors.forename: Angelika
authors.initials: A
authors.lastname: Lackner
authors.forename: Winfried B
authors.initials: WB
authors.lastname: Graninger
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
authors.forename: Christina
authors.initials: C
authors.lastname: Duftner
authors.forename: Josef
authors.initials: J
authors.lastname: Hermann
authors.forename: Christian
authors.initials: C
authors.lastname: Dejaco
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D007555:Isoxazoles / Q000627:therapeutic use; D007596:Joints / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D000077339:Leflunomide; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D013710:Tendons / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D013997:Time Factors; D018608:Ultrasonography, Doppler / Q000379:methods*
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D012460:Sulfasalazine; D000077339:Leflunomide; D008727:Methotrexate