title: Semiquantitative Evaluation of Extrasynovial Soft Tissue Inflammation in the Shoulders of Patients with Polymyalgia Rheumatica and Elderly-Onset Rheumatoid Arthritis by Power Doppler Ultrasound.
abstract: Objectives. To develop a scoring system for evaluating the extrasynovial soft tissue inflammation of the shoulders in patients with polymyalgia rheumatica (PMR) and elderly-onset rheumatoid arthritis with PMR-like onset (pm-EORA) using ultrasound.Methods. We analyzed stored power Doppler (PD) images obtained by the pretreatment examination of 15 PMR patients and 15 pm-EORA patients. A semiquantitative scoring system for evaluating the severity of PD signals adjacent to the anterior aspect of the subscapularis tendon was designed.Results. A four-point scale scoring for the hyperemia on the subscapularis tendon was proposed as follows in brief: 0 = absent or minimal flow, 1 = single vessel dots or short linear-shape signals, 2 = long linear-shape signals or short zone-shape signals, or 3 = long zone-shape signals. This scoring system showed good intra- and interobserver reliability and good correlation to quantitative pixel-counting evaluation. By using it, we demonstrated that inflammation in PMR is dominantly localized in extrasynovial soft tissue as compared with pm-EORA.Conclusions. We proposed a reliable semiquantitative scoring system using ultrasound for the evaluation of extrasynovial soft tissue inflammation of the shoulders in patients with both PMR and pm-EORA. This system is simple to use and can be utilized in future investigations.
authors.affiliation: Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan; Division of Rheumatology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.identifier: 0000-0003-0532-7478
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Ryochi
authors.initials: R
authors.lastname: Yoshida
authors.affiliation: Division of Rheumatology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Okamoto
authors.affiliation: Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Seri
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000473:pathology; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000000981:diagnostic imaging* / Q000473:pathology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012782:Shoulder / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler