Session Title: Imaging in Rheumatoid Arthritis
Session Type: Abstract Submissions (ACR)
Musculoskeletal ultrasound plays an increasingly important role in monitoring disease activity and therapy response. German US-7 score is a recently introduced ultrasound scoring index to assess soft tissue changes and bone erosions in patients with RA1. US7 score has been shown to be a viable method to monitor disease activity when performed by skilled ultrasonographers.
Our aim was to investigate the value of the German US7 score among non-experts users in daily rheumatologic practice.
One hundred patients with rheumatoid arthritis (81 females, 19 males; 25 with early and 75 with long-standing arthritis) treated with conventional DMARDs (N=84 patients) and/or biologics (N=12 patients) were enrolled. At each visit (baseline, after 3 and 6 months), clinical (TJC, SJC, DAS28), laboratory (CRP, FW) and ultrasound assessments were performed in blinded manner. Distinct pathologic features detected by ultrasound examination were assessed by eight physicians in seven joint areas (wrist, second and third metacarpophalangeal and proximal interphalangeal, and second and fifth metacarpophalangeal joints) of the clinically dominant hand and foot according to the German US7 score. Synovitis and tenosynovial vascularity due to inflammation were scored according to a 4-point semiquantitative scale (0-3) in Grey Scale (GS) and Power Doppler (PD). Tenosynovitis (GS) and erosions were scored binary (on a yes or no basis). All values are shown as mean±SD. Followed parameters and correlations were statistically analysed as a change from baseline to second follow-up using Spearman´s correlation coefficients. P values less than 0.05 were considered as statistically significant.
In this study, serum levels of C-reactive protein decreased from 7.13±8.69 at baseline to 5.71±6.6 mg/l after 6 months and DAS28 changed from 3.78±1.65 at baseline to 3.14±1.43 after 6 months. Similarly, total synovitis score in GS decreased from 7.42±6.66 at baseline to 5.05±5.29 after 6 months, synovitis score in PD decreased from 4.16±5.14 at baseline to 2.74±3.10 after 6 months. Significant correlations between change in DAS28 and synovitis improvement in GS (R=0.371, p<0.001), PD (R=0.448, p<0.001) and tenosynovitis in PD (R=0.348, p<0.0016) over 6 months were observed. Furthermore, synovitis in GS correlated significantly with synovitis in PD (R=0.445, p<0.001).
Our results show, that the German US-7 scoring system correlates well with clinical disease activity assessment even in the hands of non-expert users and thus, is a feasible tool for use in daily practice. It may be suggested that the decrease in all investigated parameters during the study period might be due to the implementation of ultrasound as a part of disease activity control influencing the treatment strategy.
References: 1. Backhaus M, Ohrndorf S, Kellner H, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009;61:1194-201.
Acknowledgements: Supported by IGA MZ CR No. NT/12437-5, MZ CR No. MZO 00023728 and GAUK No. 1010213 grants.
H. F. Mann,
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