Objectives The evaluation of inflammation is the foundation of therapy for rheumatoid arthritis (RA) and the assessment of synovial volume using ultrasound (US) is important for quantifying joint swelling. However, whether or not physicians can accurately evaluate swollen joints is uncertain. This study aimed to determine the reliability of assessments of swollen joints (SJ) by patients, physicians and US.
Methods One hundred and twenty-four patients with RA self-assessed swelling at 26 sites/22 joints (wrist, three sites; metacarpophalangeal (MP), proximal interphalangeal (PIP) joints in both sides). These joints were then assessed by the attending physician and the US examiner. Synovial hypertrophy was scored semiquantitatively using Gray scale (GS; scores 0 - 3) and Power Doppler (PD; scores, 0 - 3) signals. Swollen joints were defined as a GS score of ≥2.
Results Disease activity score (DAS) 28 closely correlated with total GS score (R=0.486, p<0.001). Among all joints 11.6% were assessed as swollen by US and 81.6% of these scored positive in PD. The sensitivity for SJ assessment by the attending doctor, the US examiner and the patients were 47.1%, 50.9% and 33.5%, respectively (Table 1). All evaluators assessed swelling less effectively in the MP, than in other joints (Table 1). The sensitivity for assessing joints with both GS ≥2 and PD ≥1 by the attending physician and the US examiner was 52.3% and 57.4%, respectively (Table 1).
Conclusions Ultrasound can assess swollen joints in patients with RA more sensitively than patients or attending physicians.
Disclosure of Interest K. Mamoto: None Declared, T. Koike Grant/Research support from: Takeda Pharmaceutical,Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, T. Okano: None Declared, M. Tada: None Declared, Y. Sugioka: None Declared, S. Wakitani: None Declared, H. Nakamura Grant/Research support from: Chugai Pharmaceutical, Astellas Pharma Inc.,Janssen Pharmaceutica, GlaxoSmithKline, Pfizer Inc. and Daiichi Sankyo, INC., Speakers Bureau: Ono Pharmaceutical