• Background/Purpose:  Sonographic quantitative and semiquantitative measurements in peripheral joints of normal subjects are yet to be defined, as are sonographic predictors of rheumatoid arthritis (RA). Our objetive was to estimate quantitative and semiquantitative ultrasound measurements predictors of RA in small, medium and large joints.
• Methods: A cross-sectional study was carried out involving 78 healthy volunteers (HV) and 60 patients with RA (ACR), matched for age group and gender. A “blind” radiologist used a My Lab 60 XVision machine (Esaote, Biomedica – Genova, Italy) with a linear array (6-18MHz) to evaluate 6.348 joint recesses. Quantitative measurements of synovial recess (QSR) (mm) and semiquantitative measurements of synovial hyperplasia (SSH), Power Doppler (SPD) and bone erosion (SBE) (scores 0-3) were performed. To determine the chance to detect RA, ROC curve analysis for QSR measurements were performed (specificity 98.7%) and, for the semiquantitative measures, an univariate logistic regression (expressed in odds ratio – OR) was carried out. P value <0.05 was set as significant.
• Results: The mean age (± SD) was 46.48 (9.14) and 43.89 (9.09), respectively for the HV and RA groups. The sample was homogeneous for gender, age group and skin color. RA group: mean disease duration was 7.89 years (± 6.76) and DAS-28 4.20 (± 1.71). Statistical difference was observed between groups for QSR (p<0.013) for most of the recesses. Mean (±SD) (mm) of QSR, respectively for HV and RA groups (HV/RA), were: radiocarpal: 2.07 (0.56)/3.24 (1.24); distal radioulnar: 1.45 (0.37)/2.28 (1.11); ulnocarpal: 1.37 (0.59)/2.74 (1.76); dorsal 2^ndMCP: 1.06 (0.53)/1.51 (0.96); palmar 2^ndMCP: 0.88 (0.60)/1.40 (1.01); dorsal 3^rdMCP: 0.81 (0.62)/1.24 (0.99); dorsal 2^ndPIP: 0.46 (0.25)/0.76 (0.64); dorsal 3^rdPIP: 0.44 (0.32)/0.83 (0.56); palmar 3^rdPIP: 0.83 (0.27)/1.11 (0.55); coronoid fossa: 0.97 (1.06)/2.18 (2.27); olecranean fossa: 1.51 (1.17)/2.79 (2.65); posterior GH recess: 2.43 (0.45)/3.03 (1.29); knee: 2.21 (1.65)/3.95 (2.96); talocrural: 2.38 (1.13)/3.34 (1.99); talonavicular: 2.67 (1.10)/3.56 (1.50); subtalar: 2.15 (1.13)/3.07 (1.71); dorsal 5^thMTP: 0.72 (0.70)/1.47 (1.11). Cutoff values of QSR specific of RA (AUC>0,700) were: radiocarpal 3.78mm; ulnocarpal 3.07mm; distal radioulnar 2.21mm; dorsal 3^rd PIP 1.19mm; knee 6.7mm and dorsal 5^th MTP 2.33mm. For semiquantitative measurements, progression from score 0 to 3, at the recesses with greater chance to detect RA were: SSH: ulnocarpal (OR=100, p<0.001); radiocarpal (OR=70, p<0.001); distal radioulnar (OR=43, p<0.001) and knee (OR=28, p<0.001); SPD: radiocarpal (OR=66, p<0.001); SBE: radiocarpal (OR=324, p=p<0.001); lateral 5^thMTP (OR=100, p=p<0.001); 2^nd MCP (dorsal and radial)(OR= 92, p<0.001) and ulnocarpal (OR=48, p<0.001). Inter-observer reliability for quantitative and semi-quantitative measures ranged from 0.563 to 0.872 and 0.341 to 0.823, respectively.
• Conclusion:  Quantitative measures specific of RA were found in almost all recesses. Semiquantitative measurements analysis showed that the worst scores found at radiocarpal, ulnocarpal and lateral 5^thMTP recesses increases the chance to detect RA. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-rheumatoid-arthritis-quantitative-and-semiquantitative-sonographic-measurements-of-peripheral-joints/