Background/Purpose: Musculoskeletal ultrasound (MUS) allows for direct visualization of diverse pathologic features such as cortical bone erosions, synovial thickening, and synovial vascularity in the joints affected by rheumatoid arthritis (RA) with high sensitivity, specificity, and accuracy.  Therefore, MUS can be a highly sensitive tool for the evaluation of disease activity in RA. However, disease activity in RA is currently measured using traditional clinical measures such as disease activity scores (DAS-28), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and Routine Assessment of Patient Index Data (RAPID-3). A limited number of studies have attempted to correlate the measures of clinical disease activity with ultrasound scores.

Purpose: To assess the correlation of different clinical activity scores with a standardized semi-quantitative US score of the dominant hand in RA patients.

Methods: This was a single center study of patients from the RA clinic at the University of Rochester. The DAS-28CRP, CDAI and SDAI are collected as a standard of care in an established RA clinic. Recently, we added RAPID 3 and offered MUS evalaution for all RA patients seen in this clinic. Clinical measures were done by AA and LGM and MUS by RT and BM. MUS was done using a GE Logiq (2014) and the following joints were assessed: dorsal wrist, 2nd, 3rd, 4th and 5th MCPs and the 2nd, 3rd, 4th and 5th PIP. MCP joints 2-5 were scanned from a dorsal aspect, and PIP joints 2-5 were scanned from a volar aspect. The scans were retrospectively scored for presence of synovitis on gray scale and the presence of Power Doppler signal (0=none; 1=mild; 2=moderate and 3=severe) for each joint, with a total score for the hand ranging from 0-54.

Results: To date, a total of 20 patients have completed all the clinical and ultrasound assessments. This cohort is comprised of 11 females and 9 males, of which 17 were sero-positive and 11 had erosive disease. The median age was 62. Scores for all parameters were available for 18 subjects (2 images could not be retrieved). In this cohort, a total of 11 patients were in remission based on DAS-28, 3 had LDA, 3 had moderate disease activity and 1 was with severe disease activity. Using CDAI, we noted that 6 patients were in remission, 7 were with LDA, 4 had moderate and 1 severe disease activity scores. By SDAI criteria, we recorded 7 in remission, 7 with LDA, 3 with moderate and 1 with severe disease activity. Based on RAPID-3, only 4 were in remission, 4 had LDA, 3 moderate and 7 had severe disease activity. The median MUS scores correlated with disease activity scors for remission, LDA, moderate and severe disease activity by DAS-28, CDAI and SDAI as shown in Table 1.

Conclusion: MUS of the dominant hand of patients with RA can provide an easy, inexpensive and accurate measure of disease activity in RA patients. MUS additionally provides the ability to visualize joint damage.

Table 1: median MUS scores for each level of clinical disease activity

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-score-of-dominant-hand-in-patients-with-rheumatoid-arthritis-correlates-with-das28crp-cdai-and-sdai-but-not-rapid-3/