Background/Purpose:

Tenosynovitis is frequent in rheumatoid arthritis (RA) patients. One study indicates that tenosynovitis detected by modern imaging has prognostic value with respect to subsequent radiographic progression. The OMERACT ultrasound (US) study group has in 2012 proposed a new tenosynovitis scoring system. However, the validation of the score is limited, eg. the sensitivity to change during treatment has not been tested.

In a 6-months follow-up study of 51 RA patients with ultrasonographic tenosynovitis, initiating treatment intensification with disease-modifying anti-rheumatic drug (DMARD) and/or biological treatment, to validate the semi-quantitative OMERACT US-scoring system of tenosynovitis by testing its interreader reliability, sensitivity to change, and comparison to clinical evaluation.

Methods:

Fifty-one RA patients, planned for treatment intensification, were included: 43 women (age: mean 55.6; standard deviation (SD) 13.1) and 8 men (mean 49.1; SD 9.34). Thirty-four patients were anti-rheumatoid factor positive and 30 had early RA (duration <1 year). US (by grey-scale (GS) and color Doppler (CD)) and clinical assessment of the flexor and extensor tendon sheaths of the clinically most affected hand and foot was performed at baseline and after 3 and 6 months. Tenosynovitis was assessed using the semi-quantitative scoring system (0-3) proposed by the OMERACT US group for GS and CD calculating a sum score (0-39) for each patient. In 20 patients, US was done independently by 2 physicians at baseline and 6 months, to assess the inter-observer agreement. A GE Logiq E9 with a linear 6-15 ML probe was used. CD frequency was 7.5 MHz, a pulse repetition frequency = 0.4 and gain just below the noise limit. The same Doppler settings were used for all examinations.  A binary score for clinical tendon involvement(0-1) was also performed at the same locations as the US score, with reference to published recommendations, calculating a sum score (0-13).

Results:

The interreader agreement, as assessed by the intra-class correlation coefficient (ICC) was very good at baseline (Bas) and for changes (Ch) for GS sum scores (ICC Bas=0.89 ; Ch=0.89) and CD (ICC Bas=0.95 ; Ch=0.90) tenosynovitis. The smallest detectable change (SDC) for change in scores was 0.97 for GS and 0.93 for CD. Tenosynovitis scores had decreased significantly at months 3 and 6 (Table 1). The sensitivity to change, as expressed by the standardized response mean from month 0-6, was high for GS and CD tenosynovitis (0.90 and 0.76, respectively), and moderate (0.59) for the clinical score (Table 1).

Conclusion:

The semi-quantitative OMERACT ultrasound scoring system of tenosynovitis showed high inter-observer agreement and sensitivity to change for both GS and CD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validity-and-sensitivity-to-change-of-the-semi-quantitative-omeract-ultrasound-scoring-system-for-tenosynovitis-in-patients-with-rheumatoid-arthritis/