From the Internal Medicine Department.
New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University.
J Clin Rheumatol. 2019 Sep;25(6):264-271. doi: 10.1097/RHU.0000000000000847.
Musculoskeletal ultrasonography (US) is an objective tool for the evaluation of disease activity in rheumatoid arthritis (RA) patients. There is no consensus on the exact number of joints that should be examined. Examination of reduced joint count is more practical than the comprehensive one.
This is a cross-sectional study investigated the validity of a 7-joint US score (US7) in assessment of joint inflammation in RA patients compared with a simplified 12-joint US score (US12) and correlated both to composite disease activity indices.
The activity status of 50 RA patients was assessed clinically and ultrasonographically. The disease activity was calculated using 3 composite indices. Ultrasonography was performed by 1 blinded rheumatologist, using power Doppler (PD) and gray-scale (GS) US examination. The US7 and simplified US12 were performed as originally described. However, the GS synovitis and PD synovitis of US12 were computed in 2 separate scores instead of 1. Two sum US7 scores were added, sum (GS) US7 and sum (PD) US7 after summating synovitis and tenosynovitis scores. Ultrasonography interobserver/intraobserver reliability was evaluated on 40 stored images.
Correlation coefficient between the different ultrasonographic scores showed no difference. The GS scores showed no correlation with disease activity parameters; however, the PD scores did. The sum (PD) US7 was the only score that showed significant correlation with the 3 different composite disease indices.
All studied US scores proved valid in assessment of disease activity status in RA. This is in favor of using the less-time-consuming US7 scores. The strongest correlation found with sum (PD) US7 confirmed the importance of incorporating the tendon in the disease activity assessment.
肌肉骨骼超声（US）是评估类风湿关节炎（RA）患者疾病活动度的客观工具。对于应该检查的关节数量，目前尚无共识。检查简化后的关节计数比全面检查更具实用性。
本横断面研究旨在探讨 7 关节超声评分（US7）在评估 RA 患者关节炎症方面的有效性，与简化的 12 关节超声评分（US12）进行比较，并与复合疾病活动指数相关。
对 50 例 RA 患者的活动状态进行临床和超声评估。使用 3 种复合指数计算疾病活动度。由 1 名盲法风湿病学家进行超声检查，使用能量多普勒（PD）和灰阶（GS）超声检查。US7 和简化的 US12 按原描述进行，但将 GS 滑膜炎和 US12 的 PD 滑膜炎分别计算为 2 个单独的评分，而不是 1 个评分。将 US7 的 GS 和 PD 滑膜炎评分相加，得到 GS 滑膜炎和 PD 滑膜炎的总和 US7 评分（sum(GS)US7 和 sum(PD)US7）。评估 40 张存储图像的超声检查观察者间/观察者内可靠性。
不同超声评分之间的相关系数无差异。GS 评分与疾病活动参数无相关性，但 PD 评分有相关性。只有 sum(PD)US7 与 3 种不同的复合疾病指数有显著相关性。
所有研究的超声评分都能有效评估 RA 的疾病活动状态。这支持使用耗时更少的 US7 评分。与 sum(PD)US7 的最强相关性证实了在疾病活动评估中纳入肌腱的重要性。
