title: On-demand ultrasonography assessment in the most symptomatic joint supports the 8-joint score system for management of rheumatoid arthritis patients.
abstract: OBJECTIVE
  To investigate whether on-demand ultrasonography (US) assessment alongside a routine examination is useful in the management of rheumatoid arthritis (RA).
  
  
  METHODS
  US was performed in eight (bilateral MCP 2, 3, wrist and knee) joints as the routine in a cumulative total of 406 RA patients. The most symptomatic joint other than the routine joints was additionally scanned. Power Doppler (PD) and gray-scale images were scored semiquantitatively. Eight-joint scores were calculated as the sum of individual scores for the routine joints.
  
  
  RESULTS
  The most symptomatic joint was found among the routine joints in 209 patients (Group A) and in other joints in 148 (Group B). The PD scores of the most symptomatic joint correlated well with the 8-joint scores in Group A (rs= 0.66), but not in Group B (rs= 0.33). The sensitivity and specificity of assessment of the most symptomatic joint for routine assessment positivity were high (84.0% and 100%, respectively) in Group A, but low (50.0% and 61.8%, respectively) in Group B. Additional examination detected synovitis in 38% of Group B with negative results in the routine.
  
  
  CONCLUSIONS
  On-demand US assessment in the most symptomatic joint, combined with the routine assessment, is useful for detecting RA synovitis.
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Yoshimi
authors.affiliation: b Department of Allergy and Rheumatology , Nippon Medical School Graduate School of Medicine , Tokyo , Japan , and.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Takeno
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Toyota
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Tsuchida
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sugiyama
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kunishita
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Daiga
authors.initials: D
authors.lastname: Kishimoto
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Reikou
authors.initials: R
authors.lastname: Kamiyama
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Minegishi
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Maasa
authors.initials: M
authors.lastname: Hama
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kirino
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
authors.affiliation: c Center for Rheumatic Disease, Yokohama City University Medical Center , Yokohama , Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ohno
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Ueda
authors.affiliation: a Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D019468:Disease Management; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler / Q000379:methods; D014955:Wrist Joint / Q000000981:diagnostic imaging*
keywords: On-demand; Power Doppler; Rheumatoid arthritis; Synovitis; Ultrasound