Background Musculoskeletal ultrasound may be a useful method for monitoring activity in rheumatoid arthritis (RA). German US-7 score is a recently introduced scoring index to assess synovitis and erosions in patients with RA1.
Objectives Our goal was to determine a feasibility of the German US-7 score among non-experts users in a pilot cohort study.
Methods A group of 100 patients with RA (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) underwent clinical examination (TJC, SJC, DAS28), laboratory tests (CRP, FW) and ultrasound assessment at baseline and after 3 and 6 months. Distinct pathologic lesions 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 semiquantitatively (0-3) in Grey Scale (GS) and Power Doppler (PD). Tenosynovitis (GS) and erosions were scored 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 below 0.05 were considered as statistically significant.
Results In this study, serum levels of CRP 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, synovitis sum 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. There were significant correlations between DAS28 reduction 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. Furthermore, synovitis in GS correlated with synovitis in PD (R=0.445, p<0.001).
Conclusions 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 well feasible method 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.
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 and MZ CR No. MZO 00023728 grants.
Disclosure of Interest None Declared