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Wrist ultrasound - the model method for grey-scale and power Doppler scoring
  1. Nirupam Purkayastha1,
  2. Frances Humby1,
  3. Vidalba Rocher-Ros1,
  4. Costantino Pitzalis1,
  5. Stephen Kelly2
  1. 1 Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University, London, UK
  2. 2 Barts Health NHS Trust, Mile End Hospital, London, UK
  1. Correspondence to Dr Nirupam Purkayastha, William Harvey Research Institute, Experimental Medicine and Rheumatology, Queen Mary University, London E1 4NS, UK; n.purkayastha{at}

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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.

Figure 1

(A) Illustration of wrist US probe positions and corresponding US images, used for US wrist assessment. (B) Fisher’s exact statistical testing for association between high and low SH/PD groups compared with high and low Krenn synovitis scores. The high US SH score is denoted by …

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  • Handling editor Josef S Smolen

  • Contributors Original concept provided by SK. Data collection, analysis and manuscript formulation by NP. All other authors contributed to the manuscript editorial process.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Research Ethics Committee.

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

  • Data sharing statement All data created are available with the permission from Costantino Pitzalis as part of the MRC PEAC study REC reference: 05/Q0703/198 and IRAS Project ID: 60271.