title: The synovial grade corresponding to clinically involved joints and a feasible ultrasound-adjusted simple disease activity index for monitoring rheumatoid arthritis.
abstract: OBJECTIVE
  To determine which grade of ultrasound (US) synovitis corresponds to clinically involved joints in rheumatoid arthritis (RA) and develops a new US-adjusted composite measure.
  
  
  METHODS
  Clinical and US examinations were performed on 137 patients with RA (28 joints). Synovial effusion, hypertrophy, and blood flow were semiquantitatively graded from 0 to 3 using gray scale (GS) and power Doppler (PD) modes. We calculated US-adjusted simple disease activity index (SDAI) and assessed feasibility, and external validity by comparing with erythrocyte sedimentation rate (ESR), and modified health assessment questionnaires (MHAQ).
  
  
  RESULTS
  GS ≥2 and PD ≥0 corresponds to clinically swollen joints, and GS ≥2 and PD ≥1 corresponds to tender joints. The US-adjusted SDAI showed the highest correlation when US-determined swollen joints were defined as PD ≥2 with ESR, and GS ≥3 and PD ≥2 with MHAQ. A feasible US-adjusted SDAI examining only clinically involved joints still showed a higher correlation with ESR and MHAQ than SDAI.
  
  
  CONCLUSIONS
  Our composite measure complemented by US only for clinically involved joints is feasible and reliable for monitoring disease activity.
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Ogasawara
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Misa
authors.initials: M
authors.lastname: Gorai
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Matsuki
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Murayama
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Nagachika
authors.initials: N
authors.lastname: Sugisaki
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nemoto
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ando
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minowa
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Souichiro
authors.initials: S
authors.lastname: Nakano
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kon
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Kurisu
authors.initials: K
authors.lastname: Tada
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaji
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.affiliation: a Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging*; D001175:Arthrography / Q000379:methods*; D001799:Blood Sedimentation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012720:Severity of Illness Index; D013585:Synovitis / Q000097:blood / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: Rheumatoid arthritis; Synovitis; Ultrasonography