Journal Article

SP0082 Do We Need A Different US Joint Count for Diagnosing, Monitoring and Remission in Ra?

Iagnocco, A.

2014

Overview

Musculoskeletal ultrasound (US) is a valuable imaging modality for detecting and quantifying a range of joint pathologies occurring in rheumatic diseases, especially RA. Recently new imaging modalities such as US are emerging as valuable tools for diagnosing, monitoring and remission in RA. US has proven its validity to assess synovitis in RA and has been demonstrated to be superior to clinical examination in the detection of inflammatory abnormalities at joint level [1]. However, RA is characterized by polyarticular and symmetrical involvement of peripheral joints and, in order to be able to assess global disease activity, it is therefore necessary to move from the level of single joints to the level of the patient as a global entity [2]. Thus, the relevance of a global but feasible ultrasonographic assessment surged proposals of different US joint count [3]. The concept of developing an US-based scoring system for synovitis in RA at patient level is based on the need for integrating the components of synovitis (i.e. synovial hypertrophy, synovial Dopper signal and joint effusion) in a unique global score of joint inflammatory activity in RA [4]. The application of a scoring system at patient level by a multi-joint US assessment aims at producing an objective tool for assessing disease activity, monitoring patients under treatment and evaluate the presence of remission [4]. In addition, the availability of a global assessment tool represents a feasible and limited-costs system that is useful in the rheumatology clinical practice as well as in clinical trials. In this context, recent studies applying either extensive or reduced US joint counts have shown the feasibility of US for following patients under treatment. However, currently there is a lack of consensus regarding the optimal number of joints to include in the global assessment as well as the appropriate scoring system to use at single joint level [4]. In addition, many differences in the responsive index applied (i.e. gray-scale synovitis, Doppler, both modalities) as well as in the correlations between US scores and clinical and laboratory findings have been registered [4–10]. Particularly, the proposed scoring systems include a variable number of joints, ranging from a maximum of 78 to a minimum of 6 [3,10]. In between, other innovative US scores have been proposed and include joints selected either bilaterally or at the level only the clinically dominant side of the body [6–8]. More recently, the development of an US global OMERACT synovitis scoring system at patient level has been proposed for being applied in multicenter international therapeutic trials aiming at testing the responsiveness of US scoring system in RA patients [4]. Further randomized controlled studies are needed for confirming these results and explore predictive aspects in respect of development of structural damage and stratification of patients. References Rizzo C et al.Ultrasound in rheumatoid arthritis. Med Ultrason. 2013;15:199-208 Mandl P et al. A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter. J Rheumatol. 2011;38:2055-62 Hammer HB et al. A 78-joints ultrasonographic assessment is associated with clinical assessments and is highly responsive to improvement in a longitudinal study of patients with rheumatoid arthritis starting adalimumab treatment. Ann Rheum Dis 2010; 69:1349-51 Iagnocco A et al. Responsiveness in Rheumatoid Arthritis. A Report from the OMERACT 11 Ultrasound Workshop. J Rheumatol. 2014;41:379-82 Naredo E et al. The OMERACT Ultrasound Task Force – Status and Perspectives. J Rheumatol 2011;38:2063-7 Naredo E et al. Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Arthritis Rheum. 2008;58:2248-56 Naredo E et al. Validity, reproducibility, and responsiveness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 2008;59:515-2216. Backhaus M et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: A pilot project. Arthritis Rheum 2009;61:1194-201 Iagnocco A et al Clinical and ultrasonographic monitoring of the response to adalimumab treatment in rheumatoid arthritis. J Rheumatol 2008;35:35-40 Perricone C et al. The 6-joint ultrasonographic assessment: a valid, sensitive-to-change and feasible method for evaluating joint inflammation in RA. Rheumatology (Oxford) 2012;51:866-73 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6184

• Publisher: Elsevier Limited