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The use of ultrasound (US) has been at the forefront of aiding diagnosis of inflammatory arthritis since its introduction. More recently, US imaging in patients with clinical remission appears to provide prognostic information with respect to disease flares and progression.1 2 Ultrasonographic scoring typically uses a semiquantitative scale of 0–3 for synovial hypertrophy (SH) and power Doppler (PD). This system works very well in smaller joints or those with single articulations. However, in complex joints such as the wrist with many articulations, the final grading can be difficult. Figure 1A illustrates three potential positions used to score wrist synovitis. As a consequence, there are a number of possible permutations for the wrist US score.
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