National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
J Rheumatol. 2011 Sep;38(9):2055-62. doi: 10.3899/jrheum.110424.
The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of synovitis in RA, a systematic analysis of the literature was performed.
A systematic literature search of Pubmed and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of synovitis.
Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination.
Ultrasound can be regarded as a valuable tool for globally examining the extent of synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed.
OMERACT 超声工作组目前正在开发一种全球滑膜炎评分（GLOSS），旨在对类风湿关节炎（RA）患者的整体疾病活动进行可行性测量。为了确定此类评分系统中需要包含的最小关节数量，并分析 RA 患者滑膜炎的拟议全局（即患者水平）超声（US）评分系统的计量学特性，对文献进行了系统分析。
对 Pubmed 和 Embase 进行了系统文献检索（1984 年 1 月 1 日至 2010 年 3 月 31 日）。包括包含 RA、超声、多普勒和评分系统的英文原始研究报告。分析了研究设计、对象、方法、成像方案和所研究的性能特征，以及滑膜炎的超声定义。
在确定的 3004 份报告中，有 14 篇文章被纳入综述。我们发现滑膜炎缺乏明确的定义，并且拟议评分的有效性数据也各不相同。评分系统包括广泛的关节数量和类型。所有分析的研究均通过临床检查、实验室发现和其他影像学方式作为比较来评估结构有效性和反应性。结构有效性和反应性均根据检查的关节数量和大小以及所测量的滑膜炎成分（即灰度（GS）或功率多普勒（PD）单独或联合）而变化。就可行性而言，评估时间从 15 分钟到 60 分钟不等，并且随着检查中涉及的关节数量的增加而增加。
超声可被视为一种评估 RA 患者滑膜炎整体程度的有价值工具。然而，目前难以确定纳入全局超声评分的最小关节数量。需要进一步验证拟议评分。
