Article Text

Download PDFPDF
Extended report
Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: results from a prospective multicentre study of rheumatoid arthritis
  1. Maxime Dougados1,
  2. Sandrine Jousse-Joulin2,
  3. Frederic Mistretta3,
  4. Maria-Antonietta d'Agostino4,
  5. Marina Backhaus5,
  6. Jacques Bentin6,
  7. Gérard Chalès7,
  8. Isabelle Chary-Valckenaere8,
  9. Philip Conaghan9,
  10. Fabien Etchepare10,
  11. Philippe Gaudin11,
  12. Walter Grassi12,
  13. Désirée van der Heijde13,
  14. Jérémie Sellam14,
  15. Esperanza Naredo15,
  16. Marcin Szkudlarek16,
  17. Richard Wakefield9,
  18. Alain Saraux2
  1. 1Paris-Descartes University, Medicine Faculty; UPRES-EA 4058; APHP, Cochin Hospital, Rheumatology B Department, Paris, France
  2. 2Brest Teaching Hospital, Rheumatology Department, Brest, France
  3. 3RCTs, Lyon, France
  4. 4Versailles-Saint Quentin en Yvelines University; APHP, Ambroise-Paré Hospital, Rheumatology Department, Boulogne-Billancourt, France
  5. 5Universitätsmedizin Berlin; Medizinische Klinik, Berlin, Germany
  6. 6CHU Brugman, Rheumatology Department, Bruxelle, Belgium
  7. 7CHU Rennes, Hôpital Sud, Rheumatology Department, Rennes, France
  8. 8CHU Nancy-Brabois, Rheumatology Department, Vandoeuvre-les-Nancy, France
  9. 9Musculoskeletal Disease University of Leeds, Leeds, UK
  10. 10Paris-VI University; APHP, La Pitié-Salpétrière Hospital, Rheumatology Department, Paris, France
  11. 11Hôpital Sud, Rheumatology Department, Grenoble, France
  12. 12Università Politecnica delle Marche, Cattedra di Reumatologia, Ancona, Italy
  13. 13Leiden University Medical Center, Leiden, The Netherlands
  14. 14Paris-XI University; APHP, Bicêtre Hospital, Rheumatology Department, Le Kremlin Bicêtre, France
  15. 15Severo Ochoa Hospital, Rheumatology Department, Madrid, Spain
  16. 16University of Copenhagen, Hvidovre Hospital, Rheumatology Department, Kettegärd Allé, Copenhagen, Denmark
  1. Correspondence to Maxime Dougados, Medicine Faculty, Rheumatology B Department, Descartes University; UPRES-EA 4058; APHP, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; m.doug{at}


Objectives To evaluate different global ultrasonographic (US) synovitis scoring systems as potential outcome measures of rheumatoid arthritis (RA) according to the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) filter.

Methods To study selected global scoring systems, for the clinical, B mode and power Doppler techniques, the following joints were evaluated: 28 joints (28-joint Disease Activity Score (DAS28)), 20 joints (metacarpophalangeals (MCPs) + metatarsophalangeals (MTPs)) and 38 joints (28 joints + MTPs) using either a binary (yes/no) or a 0–3 grade. The study was a prospective, 4-month duration follow-up of 76 patients with RA requiring anti-tumour necrosis factor (TNF) therapy (complete follow-up data: 66 patients). Intraobserver reliability was evaluated using the intraclass correlation coefficient (ICC), construct validity was evaluated using the Cronbach α test and external validity was evaluated using level of correlation between scoring system and C reactive protein (CRP). Sensitivity to change was evaluated using the standardised response mean. Discriminating capacity was evaluated using the standardised mean differences in patients considered by the doctor as significantly improved or not at the end of the study.

Results Different clinimetric properties of various US scoring systems were at least as good as the clinical scores with, for example, intraobserver reliability ranging from 0.61 to 0.97 versus from 0.53 to 0.82, construct validity ranging from 0.76 to 0.89 versus from 0.76 to 0.88, correlation with CRP ranging from 0.28 to 0.34 versus from 0.28 to 0.35 and sensitivity to change ranging from 0.60 to 1.21 versus from 0.96 to 1.36 for US versus clinical scoring systems, respectively.

Conclusion This study suggests that US evaluation of synovitis is an outcome measure at least as relevant as physical examination. Further studies are required in order to achieve optimal US scoring systems for monitoring patients with RA in clinical trials and in clinical practice.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was supported by an unrestricted grant from Abbott, France.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of each country participating in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.