TY - JOUR
T1 - Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: Results from a prospective multicentre study of rheumatoid arthritis
AU - Dougados, Maxime
AU - Jousse-Joulin, Sandrine
AU - Mistretta, Frederic
AU - D'Agostino, Maria-Antonietta
AU - D'Agostino, Maria Antonietta
AU - Backhaus, Marina
AU - Bentin, Jacques
AU - Chalès, Gérard
AU - Chary-Valckenaere, Isabelle
AU - Conaghan, Philip
AU - Etchepare, Fabien
AU - Gaudin, Philippe
AU - Grassi, Walter
AU - Van Der Heijde, Désirée
AU - Sellam, Jérémie
AU - Naredo, Esperanza
AU - Szkudlarek, Marcin
AU - Wakefield, Richard
AU - Saraux, Alain
PY - 2010
Y1 - 2010
N2 - 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.
AB - 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.
KW - Adult
KW - Aged
KW - Antirheumatic Agents
KW - Arthritis, Rheumatoid
KW - Epidemiologic Methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Observer Variation
KW - Physical Examination
KW - Synovitis
KW - Treatment Outcome
KW - Tumor Necrosis Factor-alpha
KW - Ultrasonography, Doppler
KW - Adult
KW - Aged
KW - Antirheumatic Agents
KW - Arthritis, Rheumatoid
KW - Epidemiologic Methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Observer Variation
KW - Physical Examination
KW - Synovitis
KW - Treatment Outcome
KW - Tumor Necrosis Factor-alpha
KW - Ultrasonography, Doppler
UR - http://hdl.handle.net/10807/169339
U2 - 10.1136/ard.2009.115493
DO - 10.1136/ard.2009.115493
M3 - Article
SN - 0003-4967
VL - 69
SP - 828
EP - 833
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
ER -