title: Ultrasound resistive index, power Doppler, and clinical parameters in established rheumatoid arthritis.
abstract: Ultrasonography (US) is a useful tool for the evaluation of sinovial vascularization and proliferation in rheumatoid arthritis (RA). Accordingly, resistive index (RI) on spectral Doppler (sD) US provides a quantitative analysis of vascular inflammation, but its utility in the evaluation of RA activity has not been established. Our objective was to determine the association of RI with other US parameters of synovitis and with clinical disease activity in established RA. Patients with positive power Doppler (pD) were included in a prospective cross-sectional study. Disease activity and disability were evaluated using the Disease Activity Score in 28-joints (DAS28) and Health Assessment Questionnaire (HAQ), respectively. Gray scale (GS) synovitis, pD, and sD analyses were performed by one of two examiners in wrists and the second and third metacarpophalangeal and proximal interphalangeal joints. The 10-joint GS and 10-joint pD scores and mean RI were then calculated. Weighted kappa (WK) values were employed to assess interobserver reability, and correlations were tested using the Spearman coefficient. Ninety-five RA patients (median duration of disease of 7 years and mean DAS28 of 4.32 ± 1.66) were included. WK values in real-time US were 0.77 for synovitis, 0.87 for pD, and 0.68 for RI. There were no significant correlations of RI with 10-joint GS, 10-joint pD, DAS28, joint counts, or HAQ (P > 0.10 for all tests). Patients in remission had a mean RI similar to those with high disease activity (0.62 ± 0.10, n = 15 versus 0.63 ± 0.13, n = 34, respectively). The addition of the RI score did not seem to improve US performance in patients with established RA.
authors.affiliation: Rheumatology Department, Universidade Pontifícia Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. melissabisi@gmail.com.|Rheumatology Department, São Lucas Hospital da PUCRS, Av. Ipiranga 6690, sala 220, Porto Alegre, RS, 90480-002, Brazil. melissabisi@gmail.com.
authors.forename: Melissa Cláudia
authors.initials: MC
authors.lastname: Bisi
authors.affiliation: Rheumatology Department, Universidade Pontifícia Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.|Rheumatology Service, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, RS, Brazil.
authors.forename: Aline Defaveri
authors.initials: AD
authors.lastname: do Prado
authors.affiliation: Rheumatology Department, Universidade Pontifícia Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: Deise Marcela
authors.initials: DM
authors.lastname: Piovesan
authors.affiliation: Rheumatology Service, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, RS, Brazil.
authors.forename: Markus
authors.initials: M
authors.lastname: Bredemeier
authors.affiliation: Rheumatology Department, Universidade Pontifícia Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: Inês Guimarães
authors.initials: IG
authors.lastname: da Silveira
authors.affiliation: Rheumatology Department, Universidade Pontifícia Católica de Campinas (PUCCAMP), Campinas, SP, Brazil.
authors.forename: José Alexandre
authors.initials: JA
authors.lastname: de Mendonça
authors.affiliation: Rheumatology Department, Universidade Pontifícia Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: Henrique Luiz
authors.initials: HL
authors.lastname: Staub
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler
keywords: Imaging; Imaging—ultrasound; Resistive index; Rheumatic diseases; Rheumatoid arthritis (RA); Spectral doppler