title: Development of a feasible and responsive ultrasound inflammation score for rheumatoid arthritis through a data-driven approach.
abstract: OBJECTIVE
  To develop and validate a responsive and feasible ultrasound inflammation score for rheumatoid arthritis (RA).
  
  
  METHODS
  We used data from cohorts of early RA (development) and established RA starting/switching biologic therapy (validation). 4 tendons and 36 joints were examined by a grey scale (GSUS) and power Doppler semiquantitative ultrasound (PDUS) scoring system (full score). Ultrasound score components were selected based on factor analyses of 3-month change in the development cohort. Responsiveness was assessed by standardised response means (SRMs). We assessed the proportion of information retained from the full score by linear regression.
  
  
  RESULTS
  118 patients with early and 212 patients with established RA were included. The final ultrasound score included 8 joints (metacarpophalangeal 1-2-3, proximal interphalangeal 2-3, radiocarpal, metatarsophalangeal 2-3) and 1 tendon (extensor carpi ulnaris) examined bilaterally. The 6-month SRMs for the final score were -1.24 (95% CI -1.47 to -1.02) for GSUS, and -1.09 (-1.25 to -0.92) for PDUS in early RA, with 87% of total information retained for GSUS and 90% for PDUS. The new score performed somewhat better than formerly proposed scores in the validation cohort.
  
  
  CONCLUSIONS
  The Ultrasound in Rheumatoid Arthritis 9 joint/tendon score (USRA9) inflammation score showed good responsiveness, retained most of the information from the original full score and overall performed better than previous scores in a validation cohort.
  
  
  BACKGROUND
  NCT01205854, ACTRN12610000284066; Post-results.
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Anna-Birgitte
authors.initials: AB
authors.lastname: Aga
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Hilde
authors.initials: H
authors.lastname: Berner Hammer
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Inge
authors.initials: I
authors.lastname: Christoffer Olsen
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Till
authors.initials: T
authors.lastname: Uhlig
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Department of Rheumatology , Ålesund Hospital, Helse Møre og Romsdal HF , Ålesund , Norway.
authors.forename: Hallvard
authors.initials: H
authors.lastname: Fremstad
authors.affiliation: Department of Rheumatology , Haukeland University Hospital, Helse Bergen HF , Bergen , Norway.
authors.forename: Tor Magne
authors.initials: TM
authors.lastname: Madland
authors.affiliation: Department of Rheumatology , Drammen Hospital, Vestre Viken HF , Drammen , Norway.
authors.forename: Åse Stavland
authors.initials: ÅS
authors.lastname: Lexberg
authors.affiliation: Department of Rheumatology , Martina Hansens Hospital AS , Bærum , Norway.
authors.forename: Hilde
authors.initials: H
authors.lastname: Haukeland
authors.affiliation: Department of Rheumatology , St Olavs Hospital , Trondheim University Hospital , Trondheim , Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Rødevand
authors.affiliation: Department of Rheumatology , Hospital Østfold HF , Moss , Norway.
authors.forename: Christian
authors.initials: C
authors.lastname: Høili
authors.affiliation: Haugesund Rheumatism HospitalAS , Haugesund , Norway.
authors.forename: Hilde
authors.initials: H
authors.lastname: Stray
authors.affiliation: The Rheumatology Clinic Dovland/Benvold , Kristiansand , Norway.
authors.forename: Anne Lindtner
authors.initials: AL
authors.lastname: Noraas
authors.affiliation: Department of Rheumatology , Sørlandet Hospital HF , Kristiansand , Norway.
authors.forename: Inger Johanne
authors.initials: IJ
authors.lastname: Widding Hansen
authors.affiliation: Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, University of Tromsø, Norway.
authors.forename: Gunnstein
authors.initials: G
authors.lastname: Bakland
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Lillegraven
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Espen A
authors.initials: EA
authors.lastname: Haavardsholm
keywords: Inflammation; Rheumatoid Arthritis; Ultrasonography