Background/Purpose:

The disease activity score 28 (DAS28), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are all used in the clinical assessment of rheumatoid arthritis (RA). A consensus concerning the appropriate assessment method of swollen joints has yet to be reached and standardized grading criteria are yet to be created. For our study we selected handy rheumatoid activity score, with 38 joints (HRAS38) (Mod Rheumatol (2006) 16:381–388) due to the recent attention it has gathered and performed a correlative analysis between HRAS38 assessment and musculoskeletal ultrasound by semi-quantitative grading assessment (MSKUS) for the purpose of evaluation.

Methods:

One hundred and eighty patients who satisfied either the 1987 American College of Rheumatology (ACR) or 2010 ACR/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) criteria were enrolled in this study (mean age: 62.8±14.4 years, mean DAS28-C-reactive protein (CRP): 3.06±1.43, female: 123 cases, male: 57 cases, respectively). Ten joints of the left hand (metacarpophalangeal [MCP] 1-5 joints, metaphalangeal (MP) 1 and proximal interphalangeal [PIP] 2-5 joints) were validated both with HRAS38 and MSKUS semi-quantitative grading. The 38 joints included in the evaluation were 26 joints of DAS28 except for bilateral shoulder joints, as well as 10 metatarsophalangeal (MTP) joints and the bilateral ankle joints. Each joint was scored as follows: 0 = none; 1 = mild (not convincing by observation and confirmed by palpation); 2 = moderate (convincing by observation, but not tense); 3 = severe (tense).

The MSKUS estimation was divided into gray scale (GS) (grade 0-3) and power Doppler examination (PD) (grade 0-3). The agreement between HRAS38 and MSKUS (GS and PD) was calculated using Cohen’s Kappa values. The Kappa tests for Inter-Observer variation were as follows (MCP2 = 0.77, MCP3 = 0.82, MCP4 = 0.89, PIP2 = 0.75, PIP3 = 0.87, PIP4 = 0.88, PIP5 = 0.82).

Results:

The median Kappa Value for GS examination was 0.221 and for PD examination was 0.268, respectively. Fair agreement was observed for GS of the PIP 4 (Kappa =0.505) and PD of the MCP 3 (Kappa=0.420), respectively. For the total patients who scored 0 for HRAS38, indicating no swollen joints, positive GS (GS³a1) was observed in 25.6 % of patients (387 joints / 1494 joints) and PD (PD³a1) was observed in 13.7 % of patients (205 joints / 1494 joints).

Conclusion:

According to our correlative analysis, agreement was fair between HRAS38 and MSKUS. Furthermore, analysis suggested that MSKUS is more significant in the assessment of RA, with swollen joints which were not revealed according to HRAS 38 being revealed as active synovitis by MSKUS. The authors recommend that MSKUS is used as the principal method of RA assessment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlative-analysis-of-swollen-joints-between-clinical-examination-and-musculoskeletal-ultrasound-for-rheumatoid-arthritis/