Background/Purpose: Ultrasound (US) can be a useful tool for monitoring rheumatoid arthritis (RA). However, it can be time consuming when applied to too many joints as there is lack of uniformly standardised scoring system. Thus the aim of the present study was to propose a new US score of the hands and wrist joints (US10) and to evaluate its correlation with clinical, laboratory and functional status during a 48-weeks follow-up.

Methods: Forty-eight early RA patients with less-than-1 year symptom with no previous use of disease-modifying antirheumatic drugs (DMARD) were enrolled on the study. The patients underwent clinical, laboratory assessment and blinded US examination at baseline, 3, 6, 9 and 12 months. The US10 included the following joints: wrist, second and third metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. This score was composed by the following 10 parameters,  according to inflammation:qualitative (0-1;range of 0–16) and semi-quantitative(0-3; range of 0–48) scoring to synovial proliferation(SPQ10,SPSQ10) and to power Doppler (PD) (PDQ10,PDSQ10), and qualitative (0-1) gray scale and PD scores for tenosynovitis/paratendinosis (GSTN10, PDTN, range of 0–10). A second US finding was categorised according to joint damage: a qualitative (0-1) and semi-quantitative(0-3) scoring to bone erosions (ERQ10, range of 0–12; ERSQ10, range of 0–36) and to cartilage damage (CAQ10, range of 0–4; CASQ10, range of 0–12). The following were clinical and laboratory assessments: C-reactive protein level(CRP), 28-joint Disease Activity Score (DAS 28) and Health Assessment Questionnaire (HAQ). All patients were treated with the same protocol of treatment and by just one rheumatologist.

Results: The mean ± duration of the symptoms was 7,58 ( ± 3,59) months. All patients had high activity disease with mean ± DAS 28 of 6,50 ( ± 1,29). At baseline, there was significant correlation between all US parameters for inflammation (p<0,05) and the US parameters for joint damage (ERQ10, ERSQ10 and CASQ10) also had a good significant correlation (p<0,05)with synovial proliferation parameters. Besides, significant correlation (p<0,05) between all the US10 parameters for inflammation and CRP was observed. In addition, the PD and tenosynovitis scores showed a significant correlation (p<0,05) with DAS28. Longitudinal changes through out 12 months for the inflammation parameters (SPQ10, SPSQ10, GSTN and PDTN) and for bone erosions scores showed a highly significant correlation (p<0,05). There was a significant correlation between changes in the US parameters for synovial proliferation for tenosynovitis and the DAS28 changes(SPQ10/DAS28:r=0,33,p<0,05;SPSQ10/DAS28:r=0,30,p<0,05;TNQ10/DAS28:r=0,48,p<0,05;TNQPD10:r=0,48,p<0,48) in a 12-month period. After one year, there was also a significant correlation between changes in the inflammation scores, in the CRP and in HAQ. 

Conclusion: A new US scoring system of hand and wrist joints (US10) seemed to be a useful tool to monitor inflammation and joint damage in early RA patients with a significant correlation to longitudinal changes of disease activity criteria.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-usefulness-of-a-new-musculoskeletal-ultrasound-scoring-system-of-the-hands-and-wrist-joints-us10-for-evaluation-of-early-rheumatoid-arthritis-patients/