# Structural damage in rheumatoid arthritis assessed by musculoskeletal ultrasound: A systematic literature review by the Structural Joint Damage Task Force of the OMERACT Ultrasound Working Group

I Gessl, P V Balint, E Filippucci, H I Keen, C Pineda, L Terslev, B Wildner, P Mandl, Maria Antonietta D'agostino

► To cite this version:

I Gessl, P V Balint, E Filippucci, H I Keen, C Pineda, et al.. Structural damage in rheumatoid arthritis assessed by musculoskeletal ultrasound: A systematic literature review by the Structural Joint Damage Task Force of the OMERACT Ultrasound Working Group. Seminars in Arthritis and Rheumatism, 2021, 51 (3), pp.627 - 639. 10.1016/j.searthrit.2021.02.010. hal-04548427

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Submitted on 16 Apr 2024

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tomography (CT) have been reported as sensitive and reliable alternatives to detect both cartilage damage [2,12] and bone erosions [3,13].

Musculoskeletal ultrasound has several advantages over MRI, CT and CR. Ultrasound is easily and immediately available, relatively cheap, not associated with radiation, and can be applied to almost all synovial joints within the framework of a single examination and to all patients. Joints can be additionally examined for the presence of erosions, cartilage loss but also synovitis and in addition to articular structures, the involvement of periarticular tissues such as tendon damage, tenosynovitis or enthesitis.

Several sonographic scoring systems for erosions and/ or cartilage damage have been proposed over the last few decades, none of which are utilized widely [14–18]. A semiquantitative scoring system for cartilage damage detected by ultrasound was developed recently by the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group and was shown to be reliable in the assessment of hyaline cartilage of the metacarpal head [2].

We therefore aimed to systematically review current evidence for the use of ultrasound in detecting structural joint damage in patients with RA. We furthermore aimed to gain an understanding of the definitions and scoring systems which are reported in published literature and to evaluate their metric properties according to the OMERACT filter 2.1, including recommendations for target joints.

## Methods

### Search strategy

Members of the Structural Joint Damage Task Force of the OMERACT Ultrasound WG used the “Population, Intervention, Control and Outcome” (PICO) system to develop the search strategy (Supplementary File) [19]. Subsequently, a systematic literature search with the key words rheumatoid arthritis, ultrasound, bones/cartilage/joints and damage (for exact search terms see Supplementary File) was performed in the Embase, Medline and Cochrane Central Register of Controlled Trials databases. Original articles published until October 2020 and abstracts presented at the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) annual scientific meetings from January 2018 to October 2020 assessing joint damage in RA by ultrasound were screened. To ensure not missing any suitable articles, an additional hand search was performed in Scopus. Titles, abstracts and full reports of articles were screened for inclusion and exclusion criteria. We included a) original articles or abstracts presented at EULAR or ACR scientific meeting; b) written in English; c) in which the study population included adult (≥18 years) patients with RA or suspected RA and which d) assessed damage by ultrasound. Studies were excluded if they featured less than 20 included patients with RA/suspected RA.

### Data extraction

We used a standardized template adapted from previous systematic literature reviews (SLRs) performed by the OMERACT Ultrasound WG [20]. Data from selected articles regarding study population, imaging techniques, number of included patients, joints and lesions assessed, scoring system and main findings regarding the study question were extracted.

### Assessment of quality

A quality assessment tool for diagnostic accuracy studies (QUADAS-2) was applied for all included studies to quantify quality [21]. It consists of four key domains: patient selection, index test, reference standard and flow and timing. Risk of bias and concerns regarding

applicability (only for the first three domains) were assessed for each domain for every study.

## Results

The primary search identified 1.484 articles. Eleven additional articles were found through other sources. After fulfilling inclusion and exclusion criteria and excluding duplicates, 149 studies remained and were included in the review (Fig. 1).

### Technical parameters

All studies assessed structural joint damage in gray scale. The overwhelming studies utilized high frequency, linear transducers (range 5-22 MHz). No frequency was provided in 36/149 (24.2%) studies. Other parameters for gray scale such as gain, dynamic range, number of foci, were not standardized or provided in the studies. Two studies [12] focusing on cartilage damage utilized stringent methodology corresponding to a critical review which suggested ensuring an insonation angle of 90 degrees and including the cartilage interface sign when measuring cartilage thickness [22].

### Assessed sites

The majority of the included studies assessed any joints of the hands (wrists, metacarpophalangeal, proximal interphalangeal or distal interphalangeal joints) and/or metatarsophalangeal joints (MTPs) (111/149, 74.5%). In 36/149 (24.2%) studies, other joints including the shoulders, knees, hips, sternoclavicular and temporomandibular joints were examined. Fifteen out of 149 studies (10.1%) assessed any joints of the hands and MTPs as well as other joints. All, but 22/149 (14.8%) studies assessed joints bilaterally: 12/149 (8.1%) studies [23–32] scored the clinically more affected side only. The dominant hand and the right hand were assessed in 8/149 (5.4%) [33–40] and 1/149 (0.7%) [41] studies, respectively. One study did not provide information regarding the assessed side [42] (Table 1).

### Assessed lesions

#### Bone erosions

In total, 139/149 (93.3%) included studies assessed erosions in RA patients. Among these, 107/139 (77%) studies used a binary grading (presence/ absence per patient or per joint) method. In 18/139 (12.9%) studies [16,17,25,28,30,32,34,36,41,43–51], a global erosion score was provided, calculated either as the sum of joints with at least one erosion or as the sum of joint quadrants with at least one erosion. In 44/139 (31.7%) studies, a semiquantitative score was calculated including the number and/or size of erosions. Four studies assessed erosions quantitatively by measuring the longitudinal diameter or the size of the erosions inmm [52] and/or qualitatively (shape, well-defined border, location, presence of overhanging margin) [45, 53] (Table 1).

In the majority of studies (47/139, 33.8%) erosions were assessed according to the OMERACT definition [54] published by Wakefield et al. in 2005: “intraarticular discontinuity of the bone surface that is visible in 2 perpendicular planes”. A similar definition published by Szkudlarek et al. in 2003 [55] was used in 13/139 (9.4%) included studies with “cortical break seen in two perpendicular planes”. No definition at all was provided in 46/139 (33.1%) studies. Four studies (2.9%) included size in the definition of a definitive erosion: > 1mm in 2 studies [56,57], <2mm in one study [58] and >2 mm in another study [43].

In 105/139 (75.5%) studies, any joints of the hand or the MTPs were assessed for erosions. In 27/139 (19.4%) studies, other joints including shoulder, knee, elbow, talonavicular joint, subtalar joint, hip, sternoclavicular joint and temporomandibular joint were
tomography (CT) have been reported as sensitive and reliable alternatives to detect both cartilage damage [2,12] and bone erosions [3,13].

Musculoskeletal ultrasound has several advantages over MRI, CT and CR. Ultrasound is easily and immediately available, relatively cheap, not associated with radiation, and can be applied to almost all synovial joints within the framework of a single examination and to all patients. Joints can be additionally examined for the presence of erosions, cartilage loss but also synovitis and in addition to articular structures, the involvement of periarticular tissues such as tendon damage, tenosynovitis or enthesitis.

Several sonographic scoring systems for erosions and/ or cartilage damage have been proposed over the last few decades, none of which are utilized widely [14–18]. A semiquantitative scoring system for cartilage damage detected by ultrasound was developed recently by the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group and was shown to be reliable in the assessment of hyaline cartilage of the metacarpal head [2].

We therefore aimed to systematically review current evidence for the use of ultrasound in detecting structural joint damage in patients with RA. We furthermore aimed to gain an understanding of the definitions and scoring systems which are reported in published literature and to evaluate their metric properties according to the OMERACT filter 2.1, including recommendations for target joints.

## Methods

### Search strategy

Members of the Structural Joint Damage Task Force of the OMERACT Ultrasound WG used the “Population, Intervention, Control and Outcome” (PICO) system to develop the search strategy (Supplementary File) [19]. Subsequently, a systematic literature search with the key words rheumatoid arthritis, ultrasound, bones/cartilage/joints and damage (for exact search terms see Supplementary File) was performed in the Embase, Medline and Cochrane Central Register of Controlled Trials databases. Original articles published until October 2020 and abstracts presented at the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) annual scientific meetings from January 2018 to October 2020 assessing joint damage in RA by ultrasound were screened. To ensure not missing any suitable articles, an additional hand search was performed in Scopus. Titles, abstracts and full reports of articles were screened for inclusion and exclusion criteria. We included a) original articles or abstracts presented at EULAR or ACR scientific meeting; b) written in English; c) in which the study population included adult (≥18 years) patients with RA or suspected RA and which d) assessed damage by ultrasound. Studies were excluded if they featured less than 20 included patients with RA/suspected RA.

### Data extraction

We used a standardized template adapted from previous systematic literature reviews (SLRs) performed by the OMERACT Ultrasound WG [20]. Data from selected articles regarding study population, imaging techniques, number of included patients, joints and lesions assessed, scoring system and main findings regarding the study question were extracted.

### Assessment of quality

A quality assessment tool for diagnostic accuracy studies (QUADAS-2) was applied for all included studies to quantify quality [21]. It consists of four key domains: patient selection, index test, reference standard and flow and timing. Risk of bias and concerns regarding

applicability (only for the first three domains) were assessed for each domain for every study.

## Results

The primary search identified 1.484 articles. Eleven additional articles were found through other sources. After fulfilling inclusion and exclusion criteria and excluding duplicates, 149 studies remained and were included in the review (Fig. 1).

### Technical parameters

All studies assessed structural joint damage in gray scale. The overwhelming studies utilized high frequency, linear transducers (range 5-22 MHz). No frequency was provided in 36/149 (24.2%) studies. Other parameters for gray scale such as gain, dynamic range, number of foci, were not standardized or provided in the studies. Two studies [12] focusing on cartilage damage utilized stringent methodology corresponding to a critical review which suggested ensuring an insonation angle of 90 degrees and including the cartilage interface sign when measuring cartilage thickness [22].

### Assessed sites

The majority of the included studies assessed any joints of the hands (wrists, metacarpophalangeal, proximal interphalangeal or distal interphalangeal joints) and/or metatarsophalangeal joints (MTPs) (111/149, 74.5%). In 36/149 (24.2%) studies, other joints including the shoulders, knees, hips, sternoclavicular and temporomandibular joints were examined. Fifteen out of 149 studies (10.1%) assessed any joints of the hands and MTPs as well as other joints. All, but 22/149 (14.8%) studies assessed joints bilaterally: 12/149 (8.1%) studies [23–32] scored the clinically more affected side only. The dominant hand and the right hand were assessed in 8/149 (5.4%) [33–40] and 1/149 (0.7%) [41] studies, respectively. One study did not provide information regarding the assessed side [42] (Table 1).

### Assessed lesions

#### Bone erosions

In total, 139/149 (93.3%) included studies assessed erosions in RA patients. Among these, 107/139 (77%) studies used a binary grading (presence/ absence per patient or per joint) method. In 18/139 (12.9%) studies [16,17,25,28,30,32,34,36,41,43–51], a global erosion score was provided, calculated either as the sum of joints with at least one erosion or as the sum of joint quadrants with at least one erosion. In 44/139 (31.7%) studies, a semiquantitative score was calculated including the number and/or size of erosions. Four studies assessed erosions quantitatively by measuring the longitudinal diameter or the size of the erosions inmm [52] and/or qualitatively (shape, well-defined border, location, presence of overhanging margin) [45, 53] (Table 1).

In the majority of studies (47/139, 33.8%) erosions were assessed according to the OMERACT definition [54] published by Wakefield et al. in 2005: “intraarticular discontinuity of the bone surface that is visible in 2 perpendicular planes”. A similar definition published by Szkudlarek et al. in 2003 [55] was used in 13/139 (9.4%) included studies with “cortical break seen in two perpendicular planes”. No definition at all was provided in 46/139 (33.1%) studies. Four studies (2.9%) included size in the definition of a definitive erosion: > 1mm in 2 studies [56,57], <2mm in one study [58] and >2 mm in another study [43].

In 105/139 (75.5%) studies, any joints of the hand or the MTPs were assessed for erosions. In 27/139 (19.4%) studies, other joints including shoulder, knee, elbow, talonavicular joint, subtalar joint, hip, sternoclavicular joint and temporomandibular joint were
<figure><img src="image_1.png" /><figcaption>**Fig. 1.** Flowchart of study selection.</figcaption></figure>

assessed. In 15/139 (10.8%) studies both joints of the hand or MTPs as well as other joints were assessed (Table 1).

Criterion validity assessed as comparison with other imaging methods was investigated in only 20/139 (14.4%) studies [14,23,30,37,39,50,52,59–70], while 27/120 (22.6%) of the remaining studies listed the frequency of detected erosions by ultrasound compared to MRI or CR. Validity was good to excellent (intraclass correlation coefficient (ICC) ≥0.61, kappa (K) ≥ 0.61, agreement ≥ 61% or Kendall's W ≥ 0.61) in 6/14 (42.9%) studies using a binary rating (range: sensitivity: 27-100%, correlation coefficient R (R): 0.3-0.7, K: 0.5-0.9) while 2 studies did not state the exact results. Among studies using semiquantitative scoring, validity was good to excellent in 3/4 (75%) studies (range: agreement: 65-93%, R: 0.3-0.7, Pearson's r=0.68). Inter- or intrarater reliability was assessed in 25/104 (24%) studies. Good to excellent agreement was found in 20/25 studies reporting reliability (80%). Reliability was good to excellent in 14/16 (87.5%) studies using a binary scoring (range: ICC: 0.93-0.99, K: 0.4-0.89, agreement: 88-98%, Kendall's W: 0.85, Pearson's correlation coefficient: 0.9, Gwet's AC1: 0.80), in 10/13 (76.9%) studies using semiquantitative scoring (range: ICC: 0.2-0.97, K: 0.5-1, agreement: 85-98%, R: 0.5-0.8), in 0/2 (0%) studies using a quantitative scoring (range: concordance correlation coefficient:0.5-1, ICC:0.1-0.4) and in 1/1 (100%) study using a qualitative scoring (K=0.8). Progression of erosions, defined as an increase in the number of erosions or semiquantitative score, was assessed in 16/139 (11.5%) studies [25,32,34,35,37,41,43,60,71–78], 9 (56.3%) of which showed a significant difference over time [35,37,41,43,72–74,76,78]. Sensitivity to change was found in 6/13 (46.2%) studies using a binary rating and in 3/4 (75%) using a semiquantitative rating. Feasibility was assessed in only two studies [53,79] in which ultrasound was shown to be feasible when scanning for bone erosions was restricted to few target areas (Table 2).

## Enthesophytes and osteophytes

Eight out of 149 (5.4%) studies assessed enthesophytes in RA patients [65,69,80–85]. Results were reported as binary (present/absent). Enthesophytes were assessed according to the OMERACT definition published by Terslev et al. [86] in one study. In two studies (25%) [69,85], enthesophytes were defined as “step-up of bony prominence, seen in two perpendicular planes at the end of the bone contour of the enthesis”. Interobserver agreement was reported as good (K=0.68) in a single study, while criterion validity was rated as excellent (ultrasound vs. CR; K=0.86) in an additional study [65,83]. A single study assessed insertions of the 2nd to 4th flexor tendons of the hand, while the other studies examined entheses of other joints/sites including the knee, heel, shoulder and midfoot joints (Tables 1 and 2).

Osteophytes were assessed in 15/149 (10.1%) studies [56,57,69,80,85,87–96] all of which used binary grading. One study [93] additionally assessed osteophytes quantitatively by measuring the longitudinal length. Osteophytes were defined as bony prominence or enlargement in 6/15 (40%) studies [56,57,69,85,89,91] and as irregularity of the bone contour in one study (10%) [87] while no definition was given in the remaining 8/15 (53.3%) studies. Three studies found good to excellent interobserver reliability of osteophytes (K=0.64-0.88) [89]. Seven out of 15 (46.7%) studies assessed the joints of the hand. Other studies assessed the sternoclavicular joint, the hip, the knee, the ankle and the shoulder (Tables 1 and 2).

## Cartilage damage

Among the 149 included studies, cartilage damage was assessed in 24 (16.1%) studies. Four out of the 24 included studies (16.7%) assessing cartilage used the semiquantitative score proposed by Disler et al. [77,97–99]. In the remaining studies, cartilage damage (binary/semiquantitative) was defined by partial or full thickness defects of the cartilage layer in 7/24 (29.2%) studies
<figure><img src="image_2.png" /><figcaption>**Fig. 1.** Flowchart of study selection.</figcaption></figure>

assessed. In 15/139 (10.8%) studies both joints of the hand or MTPs as well as other joints were assessed (Table 1).

Criterion validity assessed as comparison with other imaging methods was investigated in only 20/139 (14.4%) studies [14,23,30,37,39,50,52,59–70], while 27/120 (22.6%) of the remaining studies listed the frequency of detected erosions by ultrasound compared to MRI or CR. Validity was good to excellent (intraclass correlation coefficient (ICC) ≥0.61, kappa (K) ≥ 0.61, agreement ≥ 61% or Kendall's W ≥ 0.61) in 6/14 (42.9%) studies using a binary rating (range: sensitivity: 27-100%, correlation coefficient R (R): 0.3-0.7, K: 0.5-0.9) while 2 studies did not state the exact results. Among studies using semiquantitative scoring, validity was good to excellent in 3/4 (75%) studies (range: agreement: 65-93%, R: 0.3-0.7, Pearson's r=0.68). Inter- or intrarater reliability was assessed in 25/104 (24%) studies. Good to excellent agreement was found in 20/25 studies reporting reliability (80%). Reliability was good to excellent in 14/16 (87.5%) studies using a binary scoring (range: ICC: 0.93-0.99, K: 0.4-0.89, agreement: 88-98%, Kendall's W: 0.85, Pearson's correlation coefficient: 0.9, Gwet's AC1: 0.80), in 10/13 (76.9%) studies using semiquantitative scoring (range: ICC: 0.2-0.97, K: 0.5-1, agreement: 85-98%, R: 0.5-0.8), in 0/2 (0%) studies using a quantitative scoring (range: concordance correlation coefficient:0.5-1, ICC:0.1-0.4) and in 1/1 (100%) study using a qualitative scoring (K=0.8). Progression of erosions, defined as an increase in the number of erosions or semiquantitative score, was assessed in 16/139 (11.5%) studies [25,32,34,35,37,41,43,60,71–78], 9 (56.3%) of which showed a significant difference over time [35,37,41,43,72–74,76,78]. Sensitivity to change was found in 6/13 (46.2%) studies using a binary rating and in 3/4 (75%) using a semiquantitative rating. Feasibility was assessed in only two studies [53,79] in which ultrasound was shown to be feasible when scanning for bone erosions was restricted to few target areas (Table 2).

## Enthesophytes and osteophytes

Eight out of 149 (5.4%) studies assessed enthesophytes in RA patients [65,69,80–85]. Results were reported as binary (present/absent). Enthesophytes were assessed according to the OMERACT definition published by Terslev et al. [86] in one study. In two studies (25%) [69,85], enthesophytes were defined as "step-up of bony prominence, seen in two perpendicular planes at the end of the bone contour of the enthesis". Interobserver agreement was reported as good (K=0.68) in a single study, while criterion validity was rated as excellent (ultrasound vs. CR; K=0.86) in an additional study [65,83]. A single study assessed insertions of the 2nd to 4th flexor tendons of the hand, while the other studies examined entheses of other joints/sites including the knee, heel, shoulder and midfoot joints (Tables 1 and 2).

Osteophytes were assessed in 15/149 (10.1%) studies [56,57,69,80,85,87–96] all of which used binary grading. One study [93] additionally assessed osteophytes quantitatively by measuring the longitudinal length. Osteophytes were defined as bony prominence or enlargement in 6/15 (40%) studies [56,57,69,85,89,91] and as irregularity of the bone contour in one study (10%) [87] while no definition was given in the remaining 8/15 (53.3%) studies. Three studies found good to excellent interobserver reliability of osteophytes (K=0.64-0.88) [89]. Seven out of 15 (46.7%) studies assessed the joints of the hand. Other studies assessed the sternoclavicular joint, the hip, the knee, the ankle and the shoulder (Tables 1 and 2).

## Cartilage damage

Among the 149 included studies, cartilage damage was assessed in 24 (16.1%) studies. Four out of the 24 included studies (16.7%) assessing cartilage used the semiquantitative score proposed by Disler et al. [77,97–99]. In the remaining studies, cartilage damage (binary/semiquantitative) was defined by partial or full thickness defects of the cartilage layer in 7/24 (29.2%) studies
<table><caption>**Table 1**
Overview of included studies.</caption><thead><tr><th>Ref.</th><th>Population</th><th>Technique</th><th>No. patients</th><th>Joints assessed</th><th>Scoring system(s)</th><th>Lesions assessed</th></tr></thead><tbody><tr><td>[59]</td><td>RA/HC</td><td>CR/US/MRI</td><td>65</td><td>Shoulder</td><td>B</td><td>BE</td></tr><tr><td>[34]</td><td>RA/PsA</td><td>US/CR</td><td>120</td><td>MCP2.3/PIP2.3/MTP2.5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[43]</td><td>RA</td><td>US/CR</td><td>21</td><td>MCP2.5/MTP5/most swollen PIP</td><td>B/ESS</td><td>BE</td></tr><tr><td>[60]</td><td>RA</td><td>US/MR/CR/CT</td><td>49</td><td>Wrist/MCP1-5</td><td>B</td><td>BE</td></tr><tr><td>[61]</td><td>RA</td><td>US/CT</td><td>49</td><td>MCP2-5</td><td>B/S</td><td>BE</td></tr><tr><td>[117]</td><td>Susp. RA</td><td>US/CR</td><td>58</td><td>s</td><td>B</td><td>BE</td></tr><tr><td>[118]</td><td>RA</td><td>US</td><td>20</td><td>PIP2/MCP2-3/MTP5</td><td>B/S</td><td>BE</td></tr><tr><td>[35]</td><td>EA</td><td>CR/US/MRI</td><td>70</td><td>Distal ulna</td><td>S</td><td>BE</td></tr><tr><td>[119]</td><td>RA</td><td>US</td><td>48</td><td>MTP5</td><td>B</td><td>BE</td></tr><tr><td>[71]</td><td>RA</td><td>US/CR</td><td>82</td><td>Elbow/wrist/MCP2-3/ knee/ankle</td><td>B</td><td>BE</td></tr><tr><td>[17]</td><td>RA</td><td>US/CR</td><td>24</td><td>MCP1-5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[23]</td><td>RA</td><td>US/CR</td><td>38</td><td>Wrist/MCP1-5/PIP1-5/MTP 2-5</td><td>S</td><td>BE</td></tr><tr><td>[72]</td><td>RA</td><td>US</td><td>40</td><td>1 PIP/1 MCP</td><td>S</td><td>BE</td></tr><tr><td>[62]</td><td>RA</td><td>US/MRI</td><td>30</td><td>MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[66]</td><td>RA</td><td>US</td><td>30</td><td>MCP2-3/PIP2/MTP1-2</td><td>S</td><td>BE</td></tr><tr><td>[63]</td><td>RA/HC</td><td>US/MR/CR</td><td>60</td><td>MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[18]</td><td>RA/HC</td><td>US/MRI/CR</td><td>60</td><td>MTP1-5</td><td>B/S</td><td>BE</td></tr><tr><td>[33]</td><td>RA</td><td>US/CR/MRI</td><td>100</td><td>MCP1-5</td><td>B/S/Q</td><td>BE</td></tr><tr><td>[120]</td><td>RA/PsA/Go/OA/HC</td><td>US</td><td>310</td><td>Distal radius and ulna/MCP2-3,5/PIP 2-3/MTP1+5</td><td>B/S</td><td>BE</td></tr><tr><td>[73]</td><td>EA</td><td>US</td><td>63</td><td>Wrist/MCP2+5/MTP5</td><td>B/S</td><td>BE</td></tr><tr><td>[64]</td><td>RA</td><td>US/MRI</td><td>50</td><td>Wrist/MCP2-5</td><td>B</td><td>BE</td></tr><tr><td>[74]</td><td>EA</td><td>US/CR</td><td>79</td><td>Hand and feet</td><td>B</td><td>BE</td></tr><tr><td>[41]</td><td>RA</td><td>US/CR/MRI</td><td>46</td><td>Wrist/MCP1-5/PIP1-5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[24]</td><td>RA</td><td>US/CR/MRI</td><td>26</td><td>MCP1-5/MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[45]</td><td>RA/Go</td><td>US/CR</td><td>80</td><td>MTP1-5</td><td>B/ESS/QI/Q</td><td>BE</td></tr><tr><td>[75]</td><td>RA</td><td>US</td><td>274</td><td>MCP2-3+5/MTP5</td><td>B</td><td>BE</td></tr><tr><td>[50]</td><td>RA</td><td>US/CR</td><td>122</td><td>MCP2-3+5/MTP2-3+5</td><td>S/ESS</td><td>BE</td></tr><tr><td>[16]</td><td>RA</td><td>US</td><td>77</td><td>MCP1-5/PIP1-5/MTP1-5</td><td>S/ESS</td><td>BE</td></tr><tr><td>[37]</td><td>RA/AS/CTD/UA</td><td>US/CR/MRI/SZ</td><td>49</td><td>MCP1-5/PIP1-5/DIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[121]</td><td>RA</td><td>US</td><td>32</td><td>MTP2+5</td><td>B</td><td>BE</td></tr><tr><td>[25]</td><td>RA</td><td>3DUS</td><td>26</td><td>MCP2+5/MTP1+5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[76]</td><td>RA</td><td>2D/3DUS</td><td>85</td><td>MCP1-5</td><td>B</td><td>BE</td></tr><tr><td>[39]</td><td>ERA</td><td>3DUS/CT/CR</td><td>20</td><td>Wrist/MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[30]</td><td>RA</td><td>US/MRI</td><td>31</td><td>Wrist/MCP2-4/PIP2-4</td><td>B/ESS</td><td>BE</td></tr><tr><td>[52]</td><td>RA</td><td>3DUS/MRI</td><td>28</td><td>MCP2-3</td><td>B/S/Q</td><td>BE</td></tr><tr><td>[32]</td><td>RA/PsA/AS</td><td>US</td><td>45</td><td>Wrist/MCP2-3/PIP2-3/MTP2+5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[67]</td><td>RA/HC</td><td>US/HR-pQCT</td><td>81</td><td>MCP1-5/PIP1-5</td><td>B/Q</td><td>BE</td></tr><tr><td>[68]</td><td>RA</td><td>US/CR</td><td>108</td><td>MCP2-3+5/MTP2-3+5</td><td>S</td><td>BE</td></tr><tr><td>[122]</td><td>RA</td><td>US/CR</td><td>108</td><td>MCP2-3+5/MTP2-3+5</td><td>B/S</td><td>BE</td></tr><tr><td>[78]</td><td>RA</td><td>US/CR</td><td>60</td><td>WRIST/MCP1-5</td><td>B</td><td>BE</td></tr><tr><td>[70]</td><td>ERA</td><td>US/MRI</td><td>39</td><td>MTP2-5</td><td>B</td><td>BE</td></tr><tr><td>[83]</td><td>RA/PsA/HC</td><td>US</td><td>94</td><td>Flexor tendons</td><td>B</td><td>EP</td></tr><tr><td>[89]</td><td>RA/HC</td><td>US</td><td>206</td><td>STCJ</td><td>B</td><td>BE, OP</td></tr><tr><td>[65]</td><td>RA/PsA/OA</td><td>US/CR</td><td>598</td><td>Heel</td><td>B</td><td>BE, EP</td></tr><tr><td>[69]</td><td>RA</td><td>US/MRI</td><td>35</td><td>Heel, ankle</td><td>B</td><td>BE, OP, EP</td></tr><tr><td>[85]</td><td>RA/HC</td><td>US</td><td>70</td><td>Heel, ankle</td><td>B</td><td>BE, OP, EP</td></tr><tr><td>[12]</td><td>RA/HC/cadaveric specimen</td><td>US/CR</td><td>47</td><td>MCP</td><td>Q/summary score</td><td>CTh</td></tr><tr><td>[104]</td><td>RA</td><td>US</td><td>20</td><td>MCP2+3</td><td>B, S</td><td>CD</td></tr><tr><td>[27]</td><td>RA</td><td>US/MRI</td><td>30</td><td>Knee</td><td>B/IQ</td><td>CD, CTh</td></tr><tr><td>[111]</td><td>RA</td><td>US</td><td>60</td><td>Wrist/MCP2-3/PIP2-3</td><td>B/S</td><td>BE, CD</td></tr><tr><td>[14]</td><td>RA</td><td>US/CR</td><td>125</td><td>Elbow</td><td>S</td><td>BE, CD</td></tr><tr><td>[15]</td><td>RA</td><td>US/CR</td><td>425</td><td>Tender and/or swollen joints: MCP/PIP/wrist/ elbow</td><td>S</td><td>BE, CD</td></tr><tr><td>[105]</td><td>RA/HC</td><td>US</td><td>39</td><td>Wrist/MCP1-5</td><td>S</td><td>BE, CD</td></tr><tr><td>[101]</td><td>ERA</td><td>US/CR</td><td>48</td><td>Wrist/MCP2-3/PIP2-3</td><td>B/S</td><td>BE, CD</td></tr><tr><td>[77]</td><td>RA</td><td>US/CR</td><td>132</td><td>MCP1-5</td><td>S</td><td>BE, CD</td></tr><tr><td>[99]</td><td>RA/OA</td><td>US</td><td>86</td><td>MCP2-5</td><td>B/S</td><td>CD</td></tr><tr><td>[103]</td><td>RA/HC</td><td>US/CR</td><td>145</td><td>MCP2-5/PIP2-5</td><td>S/Q</td><td>CD</td></tr><tr><td>[46]</td><td>RA</td><td>2D/3DUS</td><td>31</td><td>Wrist/MCP2-3/PIP2-3/MTP2.5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[123]</td><td>ERA/RA/H/RMD</td><td>US/CR</td><td>198</td><td>Wrist/MCP1-5/PIP1-5/DIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[124]</td><td>ERA</td><td>US</td><td>34</td><td>Wrist/MCP2-5/PIP1-5</td><td>S</td><td>BE</td></tr><tr><td>[125]</td><td>RA</td><td>US</td><td>60</td><td>Wrist/MCP 1-5/PIP 1-5</td><td>B</td><td>BE</td></tr><tr><td>[126]</td><td>RA</td><td>US/CEUS</td><td>39</td><td>Wrist/MCP1-5/PIP1-5/elbow/knee</td><td>S</td><td>BE</td></tr><tr><td>[127]</td><td>RA</td><td>US</td><td>41</td><td>Wrist/MCP 1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[128]</td><td>RA/HC</td><td>US</td><td>83</td><td>Ankle</td><td>B</td><td>BE</td></tr><tr><td>[129]</td><td>EA</td><td>CR/US</td><td>126</td><td>MCP2+5/MTP5</td><td>B/S</td><td>BE</td></tr><tr><td>[130]</td><td>RA</td><td>CR/US/MRI</td><td>43</td><td>Shoulder</td><td>S</td><td>BE</td></tr><tr><td>[131]</td><td>RA</td><td>US</td><td>25</td><td>Wrist/MCP2+5/PIP3/knee</td><td>S</td><td>BE</td></tr><tr><td>[132]</td><td>RA</td><td>US</td><td>30</td><td>MCP1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[133]</td><td>RA/HC</td><td>US</td><td>138</td><td>#</td><td>B/S</td><td>BE</td></tr><tr><td>[134]</td><td>RA/HC</td><td>US</td><td>89</td><td>Shoulder</td><td>B</td><td>BE</td></tr></tbody></table>

(continued)
<table><caption>**Table 1**
Overview of included studies.</caption><thead><tr><th>Ref.</th><th>Population</th><th>Technique</th><th>No. patients</th><th>Joints assessed</th><th>Scoring system(s)</th><th>Lesions assessed</th></tr></thead><tbody><tr><td>[59]</td><td>RA/HC</td><td>CR/US/MRI</td><td>65</td><td>Shoulder</td><td>B</td><td>BE</td></tr><tr><td>[34]</td><td>RA/PsA</td><td>US/CR</td><td>120</td><td>MCP2.3/PIP2.3/MTP2.5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[43]</td><td>RA</td><td>US/CR</td><td>21</td><td>MCP2.5/MTP5/most swollen PIP</td><td>B/ESS</td><td>BE</td></tr><tr><td>[60]</td><td>RA</td><td>US/MR/CR/CT</td><td>49</td><td>Wrist/MCP1-5</td><td>B</td><td>BE</td></tr><tr><td>[61]</td><td>RA</td><td>US/CT</td><td>49</td><td>MCP2-5</td><td>B/S</td><td>BE</td></tr><tr><td>[117]</td><td>Susp. RA</td><td>US/CR</td><td>58</td><td>s</td><td>B</td><td>BE</td></tr><tr><td>[118]</td><td>RA</td><td>US</td><td>20</td><td>PIP2/MCP2-3/MTP5</td><td>B/S</td><td>BE</td></tr><tr><td>[35]</td><td>EA</td><td>CR/US/MRI</td><td>70</td><td>Distal ulna</td><td>S</td><td>BE</td></tr><tr><td>[119]</td><td>RA</td><td>US</td><td>48</td><td>MTP5</td><td>B</td><td>BE</td></tr><tr><td>[71]</td><td>RA</td><td>US/CR</td><td>82</td><td>Elbow/wrist/MCP2-3/ knee/ankle</td><td>B</td><td>BE</td></tr><tr><td>[17]</td><td>RA</td><td>US/CR</td><td>24</td><td>MCP1-5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[23]</td><td>RA</td><td>US/CR</td><td>38</td><td>Wrist/MCP1-5/PIP1-5/MTP 2-5</td><td>S</td><td>BE</td></tr><tr><td>[72]</td><td>RA</td><td>US</td><td>40</td><td>1 PIP/1 MCP</td><td>S</td><td>BE</td></tr><tr><td>[62]</td><td>RA</td><td>US/MRI</td><td>30</td><td>MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[66]</td><td>RA</td><td>US</td><td>30</td><td>MCP2-3/PIP2/MTP1-2</td><td>S</td><td>BE</td></tr><tr><td>[63]</td><td>RA/HC</td><td>US/MR/CR</td><td>60</td><td>MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[18]</td><td>RA/HC</td><td>US/MRI/CR</td><td>60</td><td>MTP1-5</td><td>B/S</td><td>BE</td></tr><tr><td>[33]</td><td>RA</td><td>US/CR/MRI</td><td>100</td><td>MCP1-5</td><td>B/S/Q</td><td>BE</td></tr><tr><td>[120]</td><td>RA/PsA/Go/OA/HC</td><td>US</td><td>310</td><td>Distal radius and ulna/MCP2-3,5/PIP 2-3/MTP1+5</td><td>B/S</td><td>BE</td></tr><tr><td>[73]</td><td>EA</td><td>US</td><td>63</td><td>Wrist/MCP2+5/MTP5</td><td>B/S</td><td>BE</td></tr><tr><td>[64]</td><td>RA</td><td>US/MRI</td><td>50</td><td>Wrist/MCP2-5</td><td>B</td><td>BE</td></tr><tr><td>[74]</td><td>EA</td><td>US/CR</td><td>79</td><td>Hand and feet</td><td>B</td><td>BE</td></tr><tr><td>[41]</td><td>RA</td><td>US/CR/MRI</td><td>46</td><td>Wrist/MCP1-5/PIP1-5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[24]</td><td>RA</td><td>US/CR/MRI</td><td>26</td><td>MCP1-5/MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[45]</td><td>RA/Go</td><td>US/CR</td><td>80</td><td>MTP1-5</td><td>B/ESS/QI/Q</td><td>BE</td></tr><tr><td>[75]</td><td>RA</td><td>US</td><td>274</td><td>MCP2-3+5/MTP5</td><td>B</td><td>BE</td></tr><tr><td>[50]</td><td>RA</td><td>US/CR</td><td>122</td><td>MCP2-3+5/MTP2-3+5</td><td>S/ESS</td><td>BE</td></tr><tr><td>[16]</td><td>RA</td><td>US</td><td>77</td><td>MCP1-5/PIP1-5/MTP1-5</td><td>S/ESS</td><td>BE</td></tr><tr><td>[37]</td><td>RA/AS/CTD/UA</td><td>US/CR/MRI/SZ</td><td>49</td><td>MCP1-5/PIP1-5/DIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[121]</td><td>RA</td><td>US</td><td>32</td><td>MTP2+5</td><td>B</td><td>BE</td></tr><tr><td>[25]</td><td>RA</td><td>3DUS</td><td>26</td><td>MCP2+5/MTP1+5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[76]</td><td>RA</td><td>2D/3DUS</td><td>85</td><td>MCP1-5</td><td>B</td><td>BE</td></tr><tr><td>[39]</td><td>ERA</td><td>3DUS/CT/CR</td><td>20</td><td>Wrist/MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[30]</td><td>RA</td><td>US/MRI</td><td>31</td><td>Wrist/MCP2-4/PIP2-4</td><td>B/ESS</td><td>BE</td></tr><tr><td>[52]</td><td>RA</td><td>3DUS/MRI</td><td>28</td><td>MCP2-3</td><td>B/S/Q</td><td>BE</td></tr><tr><td>[32]</td><td>RA/PsA/AS</td><td>US</td><td>45</td><td>Wrist/MCP2-3/PIP2-3/MTP2+5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[67]</td><td>RA/HC</td><td>US/HR-pQCT</td><td>81</td><td>MCP1-5/PIP1-5</td><td>B/Q</td><td>BE</td></tr><tr><td>[68]</td><td>RA</td><td>US/CR</td><td>108</td><td>MCP2-3+5/MTP2-3+5</td><td>S</td><td>BE</td></tr><tr><td>[122]</td><td>RA</td><td>US/CR</td><td>108</td><td>MCP2-3+5/MTP2-3+5</td><td>B/S</td><td>BE</td></tr><tr><td>[78]</td><td>RA</td><td>US/CR</td><td>60</td><td>WRIST/MCP1-5</td><td>B</td><td>BE</td></tr><tr><td>[70]</td><td>ERA</td><td>US/MRI</td><td>39</td><td>MTP2-5</td><td>B</td><td>BE</td></tr><tr><td>[83]</td><td>RA/PsA/HC</td><td>US</td><td>94</td><td>Flexor tendons</td><td>B</td><td>EP</td></tr><tr><td>[89]</td><td>RA/HC</td><td>US</td><td>206</td><td>STCJ</td><td>B</td><td>BE, OP</td></tr><tr><td>[65]</td><td>RA/PsA/OA</td><td>US/CR</td><td>598</td><td>Heel</td><td>B</td><td>BE, EP</td></tr><tr><td>[69]</td><td>RA</td><td>US/MRI</td><td>35</td><td>Heel, ankle</td><td>B</td><td>BE, OP, EP</td></tr><tr><td>[85]</td><td>RA/HC</td><td>US</td><td>70</td><td>Heel, ankle</td><td>B</td><td>BE, OP, EP</td></tr><tr><td>[12]</td><td>RA/HC/cadaveric specimen</td><td>US/CR</td><td>47</td><td>MCP</td><td>Q/summary score</td><td>CTh</td></tr><tr><td>[104]</td><td>RA</td><td>US</td><td>20</td><td>MCP2+3</td><td>B, S</td><td>CD</td></tr><tr><td>[27]</td><td>RA</td><td>US/MRI</td><td>30</td><td>Knee</td><td>B/IQ</td><td>CD, CTh</td></tr><tr><td>[111]</td><td>RA</td><td>US</td><td>60</td><td>Wrist/MCP2-3/PIP2-3</td><td>B/S</td><td>BE, CD</td></tr><tr><td>[14]</td><td>RA</td><td>US/CR</td><td>125</td><td>Elbow</td><td>S</td><td>BE, CD</td></tr><tr><td>[15]</td><td>RA</td><td>US/CR</td><td>425</td><td>Tender and/or swollen joints: MCP/PIP/wrist/ elbow</td><td>S</td><td>BE, CD</td></tr><tr><td>[105]</td><td>RA/HC</td><td>US</td><td>39</td><td>Wrist/MCP1-5</td><td>S</td><td>BE, CD</td></tr><tr><td>[101]</td><td>ERA</td><td>US/CR</td><td>48</td><td>Wrist/MCP2-3/PIP2-3</td><td>B/S</td><td>BE, CD</td></tr><tr><td>[77]</td><td>RA</td><td>US/CR</td><td>132</td><td>MCP1-5</td><td>S</td><td>BE, CD</td></tr><tr><td>[99]</td><td>RA/OA</td><td>US</td><td>86</td><td>MCP2-5</td><td>B/S</td><td>CD</td></tr><tr><td>[103]</td><td>RA/HC</td><td>US/CR</td><td>145</td><td>MCP2-5/PIP2-5</td><td>S/Q</td><td>CD</td></tr><tr><td>[46]</td><td>RA</td><td>2D/3DUS</td><td>31</td><td>Wrist/MCP2-3/PIP2-3/MTP2.5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[123]</td><td>ERA/RA/H/RMD</td><td>US/CR</td><td>198</td><td>Wrist/MCP1-5/PIP1-5/DIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[124]</td><td>ERA</td><td>US</td><td>34</td><td>Wrist/MCP2-5/PIP1-5</td><td>S</td><td>BE</td></tr><tr><td>[125]</td><td>RA</td><td>US</td><td>60</td><td>Wrist/MCP 1-5/PIP 1-5</td><td>B</td><td>BE</td></tr><tr><td>[126]</td><td>RA</td><td>US/CEUS</td><td>39</td><td>Wrist/MCP1-5/PIP1-5/elbow/knee</td><td>S</td><td>BE</td></tr><tr><td>[127]</td><td>RA</td><td>US</td><td>41</td><td>Wrist/MCP 1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[128]</td><td>RA/HC</td><td>US</td><td>83</td><td>Ankle</td><td>B</td><td>BE</td></tr><tr><td>[129]</td><td>EA</td><td>CR/US</td><td>126</td><td>MCP2+5/MTP5</td><td>B/S</td><td>BE</td></tr><tr><td>[130]</td><td>RA</td><td>CR/US/MRI</td><td>43</td><td>Shoulder</td><td>S</td><td>BE</td></tr><tr><td>[131]</td><td>RA</td><td>US</td><td>25</td><td>Wrist/MCP2+5/PIP3/knee</td><td>S</td><td>BE</td></tr><tr><td>[132]</td><td>RA</td><td>US</td><td>30</td><td>MCP1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[133]</td><td>RA/HC</td><td>US</td><td>138</td><td>#</td><td>B/S</td><td>BE</td></tr><tr><td>[134]</td><td>RA/HC</td><td>US</td><td>89</td><td>Shoulder</td><td>B</td><td>BE</td></tr></tbody></table>

(continued)
<table><caption>**Table 1 (Continued)**</caption><thead><tr><th>Ref.</th><th>Population</th><th>Technique</th><th>No. patients</th><th>Joints assessed</th><th>Scoring system(s)</th><th>Lesions assessed</th></tr></thead><tbody><tr><td>[135]</td><td>RA</td><td>US</td><td>24</td><td>MCP2-5</td><td>B/S/Q</td><td>BE</td></tr><tr><td>[136]</td><td>RA</td><td>US/CR</td><td>47</td><td>Wrist/MCP1-5/PIP 2-5</td><td>B</td><td>BE</td></tr><tr><td>[137]</td><td>EA</td><td>US/MRI</td><td>62</td><td>Wrist/MCP1-5/PIP1-5</td><td>S</td><td>BE</td></tr><tr><td>[138]</td><td>RA</td><td>US</td><td>22</td><td>MCP2-3/PIP2-3/MTP2-5</td><td>B</td><td>BE</td></tr><tr><td>[139]</td><td>EA/HC</td><td>US</td><td>84</td><td>Wrists/MCP 2-5</td><td>B</td><td>BE</td></tr><tr><td>[47]</td><td>EA</td><td>US/CR</td><td>40</td><td>MCP1-5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[140]</td><td>EA</td><td>US</td><td>174</td><td>Hand and finger joints/MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[36]</td><td>RA</td><td>US</td><td>30</td><td>Wrist/MCP2-3/PIP2-3/MTP2+5</td><td>ESS</td><td>BE</td></tr><tr><td>[141]</td><td>EA</td><td>US</td><td>40</td><td>MCP2+5</td><td>B</td><td>BE</td></tr><tr><td>[142]</td><td>RA</td><td>US</td><td>51</td><td>®</td><td>B</td><td>BE</td></tr><tr><td>[143]</td><td>EA</td><td>CR/US</td><td>30</td><td>MTP5</td><td>B/S</td><td>BE</td></tr><tr><td>[144]</td><td>RA</td><td>US/CR</td><td>122</td><td>MCP2-3+5/MTP2-3+5</td><td>S</td><td>BE</td></tr><tr><td>[53]</td><td>ERA/RA</td><td>US</td><td>110</td><td>MCP2+5/ulnar head/MTP1+5</td><td>B/Q</td><td>BE</td></tr><tr><td>[145]</td><td>IA</td><td>US/CR</td><td>144</td><td>Wrist/MCP 2-5/MTP5/most swollen PIP</td><td>B</td><td>BE</td></tr><tr><td>[38]</td><td>IA</td><td>US/MRI</td><td>32</td><td>Wrist/MCP1-5</td><td>B</td><td>BE</td></tr><tr><td>[28]</td><td>RA</td><td>US</td><td>432</td><td>Wrist/MCP2-3/PIP2-3/MTP2+5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[146]</td><td>RA</td><td>US/CR/MRI/CT</td><td>26</td><td>shoulder</td><td>B/S</td><td>BE</td></tr><tr><td>[29]</td><td>RA</td><td>US</td><td>20</td><td>Wrist/MCP2+3/PIP 2+3/MTP2+5</td><td>B</td><td>BE</td></tr><tr><td>[147]</td><td>RA</td><td>US</td><td>40</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[148]</td><td>Susp RA</td><td>US/CR</td><td>94</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[149]</td><td>ERA</td><td>US/MRI</td><td>39</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[150]</td><td>RA</td><td>US/CR</td><td>288</td><td>Wrist/MCP1-5/PIP1-5/elbow/shoulder/knee</td><td>B</td><td>BE</td></tr><tr><td>[31]</td><td>RA/AS/HC</td><td>US</td><td>114</td><td>Shoulder</td><td>B</td><td>BE</td></tr><tr><td>[151]</td><td>RA</td><td>US/MRI</td><td>30</td><td>Wrist/MCP2-4</td><td>B</td><td>BE</td></tr><tr><td>[152]</td><td>RA/OA/HC</td><td>US</td><td>156</td><td>MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[48]</td><td>RA</td><td>US/CR</td><td>30</td><td>MTP1-5/ tibiotalar joint, subtalar joint, talonavicular joint</td><td>B/ESS</td><td>BE</td></tr><tr><td>[49]</td><td>EA</td><td>US/MRI/CR</td><td>30</td><td>Wrist/MCP2-5</td><td>S/ESS</td><td>BE</td></tr><tr><td>[40]</td><td>RA</td><td>US</td><td>20</td><td>Wrist/MCP2-5/PIP2-5/MTP2-5</td><td>B/S</td><td>BE</td></tr><tr><td>[44]</td><td>EA</td><td>US/CR</td><td>127</td><td>MCP2+5/MTP5</td><td>B/ESS/S</td><td>BE</td></tr><tr><td>[153]</td><td>RA</td><td>US/CR</td><td>40</td><td>n/a</td><td>B</td><td>BE</td></tr><tr><td>[154]</td><td>RA/HC</td><td>US</td><td>120</td><td>Sternoclavicular joint</td><td>B</td><td>BE</td></tr><tr><td>[155]</td><td>RA/RMD</td><td>US</td><td>101</td><td>Wrist /MCP1-5/PIP1-5/MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[156]</td><td>RA</td><td>US</td><td>90</td><td>10 hand joints</td><td>B</td><td>BE</td></tr><tr><td>[157]</td><td>RA/HC</td><td>US</td><td>180</td><td>Wrist /MCP2-3/PIP2-3</td><td>B</td><td>BE</td></tr><tr><td>[158]</td><td>UA</td><td>US</td><td>204</td><td>Wrist /MCP2-3/PIP2-3/MTP2+5</td><td>B</td><td>BE</td></tr><tr><td>[159]</td><td>RA</td><td>US</td><td>50</td><td>Wrist/MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[160]</td><td>RA/HC</td><td>US</td><td>80</td><td>Wrist/MCP2-3/PIP2-3/MTP2+5</td><td>B/S</td><td>BE</td></tr><tr><td>[161]</td><td>RA</td><td>US</td><td>62</td><td>Wrist/MCP2-3/PIP 2-3/MTP2+5</td><td>B</td><td>BE</td></tr><tr><td>[162]</td><td>RA</td><td>US</td><td>86</td><td>Wrist</td><td>B</td><td>BE</td></tr><tr><td>[163]</td><td>RA</td><td>US/CR</td><td>50</td><td>Wrist/MCP1-5/PIP1-5</td><td>S</td><td>BE</td></tr><tr><td>[79]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[164]</td><td>RA</td><td>US</td><td>30</td><td>n/a</td><td>B</td><td>BE</td></tr><tr><td>[51]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[165]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[166]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[42]</td><td>RA</td><td>US</td><td>62</td><td>n/a</td><td>B</td><td>BE</td></tr><tr><td>[167]</td><td>RA/ACPA HC</td><td>US/CR</td><td>82</td><td>Joints of the hand and feet</td><td>B</td><td>BE</td></tr><tr><td>[168]</td><td>RA</td><td>US, MRI</td><td>80</td><td>MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[169]</td><td>ACPA HC/ ACPA arthritis</td><td>US</td><td>400</td><td>MCP2+5/MTP5</td><td>B/ S</td><td>BE</td></tr><tr><td>[170]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[171]</td><td>ACPA HC/ ACPA arthritis</td><td>US</td><td>64</td><td>Wrist/MCP1-5/ PIP1-5/DIP1-5/Joints of the feet</td><td>B</td><td>BE</td></tr><tr><td>[172]</td><td>RA</td><td>US</td><td>30</td><td>Wrist/MCP1-5/PIP1-5/MTP1-5/elbow/ankle</td><td>B</td><td>BE</td></tr><tr><td>[88]</td><td>ERA</td><td>US</td><td>98</td><td>22 joints of the hand</td><td>B</td><td>BE, OP</td></tr><tr><td>[82]</td><td>RA/AS/HC</td><td>US</td><td>62</td><td>*</td><td>B</td><td>BE, EP</td></tr><tr><td>[84]</td><td>RA/PsA</td><td>US</td><td>80</td><td>Knee</td><td>B</td><td>BE, EP</td></tr><tr><td>[57]</td><td>RA/OA/HC</td><td>US</td><td>50</td><td>MCP1-5/PIP1-5</td><td>B</td><td>BE, OP</td></tr><tr><td>[90]</td><td>RA</td><td>US</td><td>37</td><td>Shoulder</td><td>B/S</td><td>BE, OP</td></tr><tr><td>[80]</td><td>RA</td><td>US</td><td>100</td><td>Shoulder</td><td>B</td><td>BE, EP, OP</td></tr><tr><td>[56]</td><td>RA/OA/HC</td><td>US</td><td>52</td><td>MCP1-5/PIP1-5</td><td>B/S</td><td>BE, OP</td></tr><tr><td>[81]</td><td>RA</td><td>US</td><td>100</td><td>MTP1-5/PIP1-5/midfoot joints</td><td>B</td><td>BE, EP</td></tr><tr><td>[91]</td><td>RA</td><td>US</td><td>46</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE, OP</td></tr><tr><td>[92]</td><td>RA</td><td>US</td><td>224</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE, OP</td></tr><tr><td>[94]</td><td>RA/HC</td><td>US</td><td>44</td><td>SCJ/manubriosternal joint</td><td>B</td><td>BE, OP, ankylosis</td></tr><tr><td>[95]</td><td>RA</td><td>US</td><td>43</td><td>Wrist/MCP1-5/PIP1-5/elbow/shoulder/knee</td><td>B</td><td>BE, OP</td></tr><tr><td>[96]</td><td>RA/OA/HC</td><td>US</td><td>120</td><td>Wrist/MCP1-5/PIP1-5/DIP1-5</td><td>B</td><td>BE, OP</td></tr><tr><td>[108]</td><td>RA, HC</td><td>US</td><td>80</td><td>Knee</td><td>Q</td><td>CTh</td></tr><tr><td>[107]</td><td>RA/OA/HC</td><td>US</td><td>138</td><td>Knee</td><td>B/Q</td><td>CD, CTh</td></tr><tr><td>[109]</td><td>RA</td><td>US</td><td>100</td><td>Knee</td><td>B</td><td>CD, BE</td></tr><tr><td>[26]</td><td>RA/DSD</td><td>US</td><td>178</td><td>Shoulder</td><td>B</td><td>BE, CD</td></tr><tr><td>[106]</td><td>RA</td><td>US</td><td>20</td><td>MCP1-5/ hand tendons</td><td>B</td><td>BE, CD</td></tr><tr><td>[100]</td><td>RA</td><td>US/MRI</td><td>50</td><td>Wrist/MCP2-5</td><td>S</td><td>BE, CD</td></tr><tr><td>[93]</td><td>RA/OA</td><td>US</td><td>42</td><td>Knee</td><td>B</td><td>BE, CTh, OP</td></tr><tr><td>[87]</td><td>RA</td><td>US</td><td>52</td><td>Hip</td><td>B</td><td>BE, CD, OP</td></tr><tr><td>[110]</td><td>RA</td><td>US</td><td>61</td><td>Knee</td><td>Q</td><td>CTh</td></tr></tbody></table>

(continued)
<table><caption>**Table 1 (Continued)**</caption><thead><tr><th>Ref.</th><th>Population</th><th>Technique</th><th>No. patients</th><th>Joints assessed</th><th>Scoring system(s)</th><th>Lesions assessed</th></tr></thead><tbody><tr><td>[135]</td><td>RA</td><td>US</td><td>24</td><td>MCP2-5</td><td>B/S/Q</td><td>BE</td></tr><tr><td>[136]</td><td>RA</td><td>US/CR</td><td>47</td><td>Wrist/MCP1-5/PIP 2-5</td><td>B</td><td>BE</td></tr><tr><td>[137]</td><td>EA</td><td>US/MRI</td><td>62</td><td>Wrist/MCP1-5/PIP1-5</td><td>S</td><td>BE</td></tr><tr><td>[138]</td><td>RA</td><td>US</td><td>22</td><td>MCP2-3/PIP2-3/MTP2-5</td><td>B</td><td>BE</td></tr><tr><td>[139]</td><td>EA/HC</td><td>US</td><td>84</td><td>Wrists/MCP 2-5</td><td>B</td><td>BE</td></tr><tr><td>[47]</td><td>EA</td><td>US/CR</td><td>40</td><td>MCP1-5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[140]</td><td>EA</td><td>US</td><td>174</td><td>Hand and finger joints/MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[36]</td><td>RA</td><td>US</td><td>30</td><td>Wrist/MCP2-3/PIP2-3/MTP2+5</td><td>ESS</td><td>BE</td></tr><tr><td>[141]</td><td>EA</td><td>US</td><td>40</td><td>MCP2+5</td><td>B</td><td>BE</td></tr><tr><td>[142]</td><td>RA</td><td>US</td><td>51</td><td>®</td><td>B</td><td>BE</td></tr><tr><td>[143]</td><td>EA</td><td>CR/US</td><td>30</td><td>MTP5</td><td>B/S</td><td>BE</td></tr><tr><td>[144]</td><td>RA</td><td>US/CR</td><td>122</td><td>MCP2-3+5/MTP2-3+5</td><td>S</td><td>BE</td></tr><tr><td>[53]</td><td>ERA/RA</td><td>US</td><td>110</td><td>MCP2+5/ulnar head/MTP1+5</td><td>B/Q</td><td>BE</td></tr><tr><td>[145]</td><td>IA</td><td>US/CR</td><td>144</td><td>Wrist/MCP 2-5/MTP5/most swollen PIP</td><td>B</td><td>BE</td></tr><tr><td>[38]</td><td>IA</td><td>US/MRI</td><td>32</td><td>Wrist/MCP1-5</td><td>B</td><td>BE</td></tr><tr><td>[28]</td><td>RA</td><td>US</td><td>432</td><td>Wrist/MCP2-3/PIP2-3/MTP2+5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[146]</td><td>RA</td><td>US/CR/MRI/CT</td><td>26</td><td>shoulder</td><td>B/S</td><td>BE</td></tr><tr><td>[29]</td><td>RA</td><td>US</td><td>20</td><td>Wrist/MCP2+3/PIP 2+3/MTP2+5</td><td>B</td><td>BE</td></tr><tr><td>[147]</td><td>RA</td><td>US</td><td>40</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[148]</td><td>Susp RA</td><td>US/CR</td><td>94</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[149]</td><td>ERA</td><td>US/MRI</td><td>39</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE</td></tr><tr><td>[150]</td><td>RA</td><td>US/CR</td><td>288</td><td>Wrist/MCP1-5/PIP1-5/elbow/shoulder/knee</td><td>B</td><td>BE</td></tr><tr><td>[31]</td><td>RA/AS/HC</td><td>US</td><td>114</td><td>Shoulder</td><td>B</td><td>BE</td></tr><tr><td>[151]</td><td>RA</td><td>US/MRI</td><td>30</td><td>Wrist/MCP2-4</td><td>B</td><td>BE</td></tr><tr><td>[152]</td><td>RA/OA/HC</td><td>US</td><td>156</td><td>MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[48]</td><td>RA</td><td>US/CR</td><td>30</td><td>MTP1-5/ tibiotalar joint, subtalar joint, talonavicular joint</td><td>B/ESS</td><td>BE</td></tr><tr><td>[49]</td><td>EA</td><td>US/MRI/CR</td><td>30</td><td>Wrist/MCP2-5</td><td>S/ESS</td><td>BE</td></tr><tr><td>[40]</td><td>RA</td><td>US</td><td>20</td><td>Wrist/MCP2-5/PIP2-5/MTP2-5</td><td>B/S</td><td>BE</td></tr><tr><td>[44]</td><td>EA</td><td>US/CR</td><td>127</td><td>MCP2+5/MTP5</td><td>B/ESS/S</td><td>BE</td></tr><tr><td>[153]</td><td>RA</td><td>US/CR</td><td>40</td><td>n/a</td><td>B</td><td>BE</td></tr><tr><td>[154]</td><td>RA/HC</td><td>US</td><td>120</td><td>Sternoclavicular joint</td><td>B</td><td>BE</td></tr><tr><td>[155]</td><td>RA/RMD</td><td>US</td><td>101</td><td>Wrist /MCP1-5/PIP1-5/MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[156]</td><td>RA</td><td>US</td><td>90</td><td>10 hand joints</td><td>B</td><td>BE</td></tr><tr><td>[157]</td><td>RA/HC</td><td>US</td><td>180</td><td>Wrist /MCP2-3/PIP2-3</td><td>B</td><td>BE</td></tr><tr><td>[158]</td><td>UA</td><td>US</td><td>204</td><td>Wrist /MCP2-3/PIP2-3/MTP2+5</td><td>B</td><td>BE</td></tr><tr><td>[159]</td><td>RA</td><td>US</td><td>50</td><td>Wrist/MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[160]</td><td>RA/HC</td><td>US</td><td>80</td><td>Wrist/MCP2-3/PIP2-3/MTP2+5</td><td>B/S</td><td>BE</td></tr><tr><td>[161]</td><td>RA</td><td>US</td><td>62</td><td>Wrist/MCP2-3/PIP 2-3/MTP2+5</td><td>B</td><td>BE</td></tr><tr><td>[162]</td><td>RA</td><td>US</td><td>86</td><td>Wrist</td><td>B</td><td>BE</td></tr><tr><td>[163]</td><td>RA</td><td>US/CR</td><td>50</td><td>Wrist/MCP1-5/PIP1-5</td><td>S</td><td>BE</td></tr><tr><td>[79]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[164]</td><td>RA</td><td>US</td><td>30</td><td>n/a</td><td>B</td><td>BE</td></tr><tr><td>[51]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B/ESS</td><td>BE</td></tr><tr><td>[165]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[166]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[42]</td><td>RA</td><td>US</td><td>62</td><td>n/a</td><td>B</td><td>BE</td></tr><tr><td>[167]</td><td>RA/ACPA HC</td><td>US/CR</td><td>82</td><td>Joints of the hand and feet</td><td>B</td><td>BE</td></tr><tr><td>[168]</td><td>RA</td><td>US, MRI</td><td>80</td><td>MCP2-5/PIP2-5</td><td>B</td><td>BE</td></tr><tr><td>[169]</td><td>ACPA HC/ ACPA arthritis</td><td>US</td><td>400</td><td>MCP2+5/MTP5</td><td>B/ S</td><td>BE</td></tr><tr><td>[170]</td><td>RA</td><td>US</td><td>30</td><td>Elbow/Wrist/MCP1-5/PIP1-5, ankle, MTP1-5</td><td>B</td><td>BE</td></tr><tr><td>[171]</td><td>ACPA HC/ ACPA arthritis</td><td>US</td><td>64</td><td>Wrist/MCP1-5/ PIP1-5/DIP1-5/Joints of the feet</td><td>B</td><td>BE</td></tr><tr><td>[172]</td><td>RA</td><td>US</td><td>30</td><td>Wrist/MCP1-5/PIP1-5/MTP1-5/elbow/ankle</td><td>B</td><td>BE</td></tr><tr><td>[88]</td><td>ERA</td><td>US</td><td>98</td><td>22 joints of the hand</td><td>B</td><td>BE, OP</td></tr><tr><td>[82]</td><td>RA/AS/HC</td><td>US</td><td>62</td><td>*</td><td>B</td><td>BE, EP</td></tr><tr><td>[84]</td><td>RA/PsA</td><td>US</td><td>80</td><td>Knee</td><td>B</td><td>BE, EP</td></tr><tr><td>[57]</td><td>RA/OA/HC</td><td>US</td><td>50</td><td>MCP1-5/PIP1-5</td><td>B</td><td>BE, OP</td></tr><tr><td>[90]</td><td>RA</td><td>US</td><td>37</td><td>Shoulder</td><td>B/S</td><td>BE, OP</td></tr><tr><td>[80]</td><td>RA</td><td>US</td><td>100</td><td>Shoulder</td><td>B</td><td>BE, EP, OP</td></tr><tr><td>[56]</td><td>RA/OA/HC</td><td>US</td><td>52</td><td>MCP1-5/PIP1-5</td><td>B/S</td><td>BE, OP</td></tr><tr><td>[81]</td><td>RA</td><td>US</td><td>100</td><td>MTP1-5/PIP1-5/midfoot joints</td><td>B</td><td>BE, EP</td></tr><tr><td>[91]</td><td>RA</td><td>US</td><td>46</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE, OP</td></tr><tr><td>[92]</td><td>RA</td><td>US</td><td>224</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE, OP</td></tr><tr><td>[94]</td><td>RA/HC</td><td>US</td><td>44</td><td>SCJ/manubriosternal joint</td><td>B</td><td>BE, OP, ankylosis</td></tr><tr><td>[95]</td><td>RA</td><td>US</td><td>43</td><td>Wrist/MCP1-5/PIP1-5/elbow/shoulder/knee</td><td>B</td><td>BE, OP</td></tr><tr><td>[96]</td><td>RA/OA/HC</td><td>US</td><td>120</td><td>Wrist/MCP1-5/PIP1-5/DIP1-5</td><td>B</td><td>BE, OP</td></tr><tr><td>[108]</td><td>RA, HC</td><td>US</td><td>80</td><td>Knee</td><td>Q</td><td>CTh</td></tr><tr><td>[107]</td><td>RA/OA/HC</td><td>US</td><td>138</td><td>Knee</td><td>B/Q</td><td>CD, CTh</td></tr><tr><td>[109]</td><td>RA</td><td>US</td><td>100</td><td>Knee</td><td>B</td><td>CD, BE</td></tr><tr><td>[26]</td><td>RA/DSD</td><td>US</td><td>178</td><td>Shoulder</td><td>B</td><td>BE, CD</td></tr><tr><td>[106]</td><td>RA</td><td>US</td><td>20</td><td>MCP1-5/ hand tendons</td><td>B</td><td>BE, CD</td></tr><tr><td>[100]</td><td>RA</td><td>US/MRI</td><td>50</td><td>Wrist/MCP2-5</td><td>S</td><td>BE, CD</td></tr><tr><td>[93]</td><td>RA/OA</td><td>US</td><td>42</td><td>Knee</td><td>B</td><td>BE, CTh, OP</td></tr><tr><td>[87]</td><td>RA</td><td>US</td><td>52</td><td>Hip</td><td>B</td><td>BE, CD, OP</td></tr><tr><td>[110]</td><td>RA</td><td>US</td><td>61</td><td>Knee</td><td>Q</td><td>CTh</td></tr></tbody></table>

(continued)
<table><caption>**Table 1 (Continued)**</caption><thead><tr><th>Ref.</th><th>Population</th><th>Technique</th><th>No. patients</th><th>Joints assessed</th><th>Scoring system(s)</th><th>Lesions assessed</th></tr></thead><tbody><tr><td>[112]</td><td>RA</td><td>US</td><td>60</td><td>Wrist/MCP1-5</td><td>S</td><td>BE, CD</td></tr><tr><td>[116]</td><td>RA</td><td>US/CR/MRI</td><td>20</td><td>TMJ</td><td>B/S</td><td>BE, DDP</td></tr><tr><td>[113]</td><td>RA</td><td>US</td><td>100</td><td>Wrist/MCP1-5/PIP1-5</td><td>B,S</td><td>BE, CD</td></tr><tr><td>[102]</td><td>RA/HC</td><td>US</td><td>40</td><td>MCP2-5</td><td>S/Q</td><td>CD, CTh</td></tr><tr><td>[114]</td><td>RA</td><td>US</td><td>53</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE, CD</td></tr></tbody></table>

⁵MCP1-5, PIP1-5, PIP2-5, elbow, wrist, shoulder, knee, ankle.

*PIP 2.3; MCP 2.3; MTP 1, 2, 5, wrist, elbow, shoulder, hip, knee, ankle, talonavicular joint, subtalar joint.

Achilles tendon, plantar fascia, quadriceps tendon insertion on patella, patellar tendon insertion on the distal pole of the patella, tibialis anterior tendon, triceps tendon, common flexor and extensor tendons.

*Patella, plantar tendon insertion at the tibial tuberosity, Achilles tendon, plantar aponeurosis, supraspinatus tendon, biceps brachii tendon AC, accuracy; AG, agreement; AS, axial spondylarthritis; B, binary; BE, bone erosions; CD, cartilage damage; CT, computed tomography; CTD, connective tissue disease; CTh, cartilage thickness; CR, conventional radiograph; EA, early arthritis; EP, enthesophyte; ERA, early rheumatoid arthritis; ESS, erosion summary score; Go, gout; HC, healthy control; HR-pQCT, high-resolution peripheral quantitative computed tomography; MCP, metacarpophalangeal joint; MRI, magnetic resonance imaging; MTP, metatarsophalangeal joint; OA, osteoarthritis; PIP, proximal interphalangeal joint; PsA, psoriatic arthritis; Q, quantitative; RA, rheumatoid arthritis; S, semiquantitative; STCJ, sternoclavicular joint; SZ, bone scintigraphy; TMJ, temporomandibular joint; UA, undifferentiated arthritis; US, ultrasound.

<table><caption>**Table 2**

Overview of included studies and reliability, validity, feasibility or sensitivity to change.</caption><thead><tr><th>Ref.</th><th>Reliability</th><th>Validity</th><th>Feasibility</th><th>STC</th></tr></thead><tbody><tr><td>[59]</td><td>Intrarater</td><td>SE: 85.4%</td><td>n/a</td><td>n/a</td></tr><tr><td>[34]</td><td>K: 0.64</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[43]</td><td>n/a</td><td>K: 0.98</td><td>n/a</td><td>Y</td></tr><tr><td>[60]</td><td>ICC: 0.93</td><td>n/a</td><td>SE: 44%/ SP: 95%/ ACC:84%</td><td>N</td></tr><tr><td>[61]</td><td>n/a</td><td>n/a</td><td>SE: 44%/ SP: 95%/ ACC:84%</td><td>n/a</td></tr><tr><td>[117]</td><td>K: 0.93</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[118]</td><td>n/a</td><td>K: 0.4-0.99</td><td>n/a</td><td>n/a</td></tr><tr><td>[35]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[119]</td><td>n/a</td><td>K: 0.8</td><td>n/a</td><td>n/a</td></tr><tr><td>[71]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[17]</td><td>n/a</td><td>K: 0.74</td><td>n/a</td><td>n/a</td></tr><tr><td>[23]</td><td>n/a</td><td>n/a</td><td>R: 0.41-0.81</td><td>n/a</td></tr><tr><td>[72]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[62]</td><td>n/a</td><td>K: 0.55</td><td>n/a</td><td>n/a</td></tr><tr><td>[66]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[63]</td><td>n/a</td><td>AC: 0.96/ SE:0.59/ SP: 0.98</td><td>n/a</td><td>n/a</td></tr><tr><td>[18]</td><td>n/a</td><td>SE: 0.79/ SP: 0.97/ AC: 0.96</td><td>n/a</td><td>n/a</td></tr><tr><td>[33]</td><td>K: 0.75</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[120]</td><td>K: 0.82-0.87</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[73]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[64]</td><td>n/a</td><td>K: 0.48</td><td>n/a</td><td>n/a</td></tr><tr><td>[74]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[41]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[24]</td><td>n/a</td><td>K: 0.81</td><td>n/a</td><td>n/a</td></tr><tr><td>[45]</td><td>n/a</td><td>K: 0.81</td><td>n/a</td><td>n/a</td></tr><tr><td>[75]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[50]</td><td>ICC: 0.96</td><td>ICC: 0.97</td><td>AG: 0.93</td><td>n/a</td></tr><tr><td>[16]</td><td>n/a</td><td>K: 0.72</td><td>n/a</td><td>n/a</td></tr><tr><td>[37]</td><td>n/a</td><td>n/a</td><td>SE</td><td>Y</td></tr><tr><td>[121]</td><td>n/a</td><td>K: 0.64</td><td>n/a</td><td>n/a</td></tr><tr><td>[25]</td><td>ICC: 0.99</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[76]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[39]</td><td>n/a</td><td>KW: 0.85</td><td>SE: 0.9/ SP: 0.55</td><td>n/a</td></tr><tr><td>[30]</td><td>n/a</td><td>K: 0.59</td><td>SE: 0.27-1/ SP: 0.47-0.75</td><td>n/a</td></tr><tr><td>[52]</td><td>ICC: 0.13-0.86</td><td>n/a</td><td>R: 0.26-0.75</td><td>n/a</td></tr><tr><td>[32]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[67]</td><td>P>0.9</td><td>n/a</td><td>SP: 0.97-1/ SE: 0.4-0.5</td><td>n/a</td></tr><tr><td>[68]</td><td>n/a</td><td>n/a</td><td>P: 0.68</td><td>n/a</td></tr><tr><td>[122]</td><td>ICC: 0.96/ G: 0.81</td><td>ICC: 0.97</td><td>n/a</td><td>n/a</td></tr><tr><td>[78]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[70]</td><td>n/a</td><td>n/a</td><td>K: 0.01</td><td>n/a</td></tr><tr><td>[83]</td><td>n/a</td><td>K: 0.69</td><td>n/a</td><td>n/a</td></tr><tr><td>[89]</td><td>n/a</td><td>K: BE: 0.7/ OP: 0.65</td><td>n/a</td><td>n/a</td></tr><tr><td>[65]</td><td>n/a</td><td>n/a</td><td>K: BE: 0.86/ EP: 0.83-0.89</td><td>n/a</td></tr><tr><td>[69]</td><td>n/a</td><td>K: BE: 0.65-0.89/ OP: 0.64-0.83</td><td>K: BE: 0.06/ OP: K: 0.26</td><td>n/a</td></tr><tr><td>[85]</td><td>n/a</td><td>K: 0.71-0.88</td><td>n/a</td><td>n/a</td></tr><tr><td>[12]</td><td>ICC: 0.8</td><td>ICC: 0.8</td><td>ICC: 0.61</td><td>n/a</td></tr><tr><td>[104]</td><td>n/a</td><td>K: 0.36-0.83</td><td>n/a</td><td>n/a</td></tr><tr><td>[27]</td><td>n/a</td><td>n/a</td><td>K: 0.66-0.85</td><td>n/a</td></tr><tr><td>[111]</td><td>n/a</td><td>K: BE: 0.7-1/ CD: 0.3-0.6</td><td>n/a</td><td>n/a</td></tr><tr><td>[14]</td><td>AG: 0.91</td><td>AG: 0.89</td><td>AG: 0.65</td><td>n/a</td></tr></tbody></table>

(continued)
<table><caption>**Table 1 (Continued)**</caption><thead><tr><th>Ref.</th><th>Population</th><th>Technique</th><th>No. patients</th><th>Joints assessed</th><th>Scoring system(s)</th><th>Lesions assessed</th></tr></thead><tbody><tr><td>[112]</td><td>RA</td><td>US</td><td>60</td><td>Wrist/MCP1-5</td><td>S</td><td>BE, CD</td></tr><tr><td>[116]</td><td>RA</td><td>US/CR/MRI</td><td>20</td><td>TMJ</td><td>B/S</td><td>BE, DDP</td></tr><tr><td>[113]</td><td>RA</td><td>US</td><td>100</td><td>Wrist/MCP1-5/PIP1-5</td><td>B,S</td><td>BE, CD</td></tr><tr><td>[102]</td><td>RA/HC</td><td>US</td><td>40</td><td>MCP2-5</td><td>S/Q</td><td>CD, CTh</td></tr><tr><td>[114]</td><td>RA</td><td>US</td><td>53</td><td>Wrist/MCP1-5/PIP1-5</td><td>B</td><td>BE, CD</td></tr></tbody></table>

⁵MCP1-5, PIP1-5, PIP2-5, elbow, wrist, shoulder, knee, ankle.

*PIP 2.3; MCP 2.3; MTP 1, 2, 5, wrist, elbow, shoulder, hip, knee, ankle, talonavicular joint, subtalar joint.

Achilles tendon, plantar fascia, quadriceps tendon insertion on patella, patellar tendon insertion on the distal pole of the patella, tibialis anterior tendon, triceps tendon, common flexor and extensor tendons.

*Patella, plantar tendon insertion at the tibial tuberosity, Achilles tendon, plantar aponeurosis, supraspinatus tendon, biceps brachii tendon AC, accuracy; AG, agreement; AS, axial spondylarthritis; B, binary; BE, bone erosions; CD, cartilage damage; CT, computed tomography; CTD, connective tissue disease; CTh, cartilage thickness; CR, conventional radiograph; EA, early arthritis; EP, enthesophyte; ERA, early rheumatoid arthritis; ESS, erosion summary score; Go, gout; HC, healthy control; HR-pQCT, high-resolution peripheral quantitative computed tomography; MCP, metacarpophalangeal joint; MRI, magnetic resonance imaging; MTP, metatarsophalangeal joint; OA, osteoarthritis; PIP, proximal interphalangeal joint; PsA, psoriatic arthritis; Q, quantitative; RA, rheumatoid arthritis; S, semiquantitative; STCJ, sternoclavicular joint; SZ, bone scintigraphy; TMJ, temporomandibular joint; UA, undifferentiated arthritis; US, ultrasound.

<table><caption>**Table 2**

Overview of included studies and reliability, validity, feasibility or sensitivity to change.</caption><thead><tr><th>Ref.</th><th>Reliability</th><th>Validity</th><th>Feasibility</th><th>STC</th></tr></thead><tbody><tr><td>[59]</td><td>Intrarater</td><td>SE: 85.4%</td><td>n/a</td><td>n/a</td></tr><tr><td>[34]</td><td>K: 0.64</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[43]</td><td>n/a</td><td>K: 0.98</td><td>n/a</td><td>Y</td></tr><tr><td>[60]</td><td>ICC: 0.93</td><td>n/a</td><td>SE: 44%/ SP: 95%/ ACC:84%</td><td>N</td></tr><tr><td>[61]</td><td>n/a</td><td>n/a</td><td>SE: 44%/ SP: 95%/ ACC:84%</td><td>n/a</td></tr><tr><td>[117]</td><td>K: 0.93</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[118]</td><td>n/a</td><td>K: 0.4-0.99</td><td>n/a</td><td>n/a</td></tr><tr><td>[35]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[119]</td><td>n/a</td><td>K: 0.8</td><td>n/a</td><td>n/a</td></tr><tr><td>[71]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[17]</td><td>n/a</td><td>K: 0.74</td><td>n/a</td><td>n/a</td></tr><tr><td>[23]</td><td>n/a</td><td>n/a</td><td>R: 0.41-0.81</td><td>n/a</td></tr><tr><td>[72]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[62]</td><td>n/a</td><td>K: 0.55</td><td>n/a</td><td>n/a</td></tr><tr><td>[66]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[63]</td><td>n/a</td><td>AC: 0.96/ SE:0.59/ SP: 0.98</td><td>n/a</td><td>n/a</td></tr><tr><td>[18]</td><td>n/a</td><td>SE: 0.79/ SP: 0.97/ AC: 0.96</td><td>n/a</td><td>n/a</td></tr><tr><td>[33]</td><td>K: 0.75</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[120]</td><td>K: 0.82-0.87</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[73]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[64]</td><td>n/a</td><td>K: 0.48</td><td>n/a</td><td>n/a</td></tr><tr><td>[74]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[41]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[24]</td><td>n/a</td><td>K: 0.81</td><td>n/a</td><td>n/a</td></tr><tr><td>[45]</td><td>n/a</td><td>K: 0.81</td><td>n/a</td><td>n/a</td></tr><tr><td>[75]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[50]</td><td>ICC: 0.96</td><td>ICC: 0.97</td><td>AG: 0.93</td><td>n/a</td></tr><tr><td>[16]</td><td>n/a</td><td>K: 0.72</td><td>n/a</td><td>n/a</td></tr><tr><td>[37]</td><td>n/a</td><td>n/a</td><td>SE</td><td>Y</td></tr><tr><td>[121]</td><td>n/a</td><td>K: 0.64</td><td>n/a</td><td>n/a</td></tr><tr><td>[25]</td><td>ICC: 0.99</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[76]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[39]</td><td>n/a</td><td>KW: 0.85</td><td>SE: 0.9/ SP: 0.55</td><td>n/a</td></tr><tr><td>[30]</td><td>n/a</td><td>K: 0.59</td><td>SE: 0.27-1/ SP: 0.47-0.75</td><td>n/a</td></tr><tr><td>[52]</td><td>ICC: 0.13-0.86</td><td>n/a</td><td>R: 0.26-0.75</td><td>n/a</td></tr><tr><td>[32]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>N</td></tr><tr><td>[67]</td><td>P&gt;0.9</td><td>n/a</td><td>SP: 0.97-1/ SE: 0.4-0.5</td><td>n/a</td></tr><tr><td>[68]</td><td>n/a</td><td>n/a</td><td>P: 0.68</td><td>n/a</td></tr><tr><td>[122]</td><td>ICC: 0.96/ G: 0.81</td><td>ICC: 0.97</td><td>n/a</td><td>n/a</td></tr><tr><td>[78]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>Y</td></tr><tr><td>[70]</td><td>n/a</td><td>n/a</td><td>K: 0.01</td><td>n/a</td></tr><tr><td>[83]</td><td>n/a</td><td>K: 0.69</td><td>n/a</td><td>n/a</td></tr><tr><td>[89]</td><td>n/a</td><td>K: BE: 0.7/ OP: 0.65</td><td>n/a</td><td>n/a</td></tr><tr><td>[65]</td><td>n/a</td><td>n/a</td><td>K: BE: 0.86/ EP: 0.83-0.89</td><td>n/a</td></tr><tr><td>[69]</td><td>n/a</td><td>K: BE: 0.65-0.89/ OP: 0.64-0.83</td><td>K: BE: 0.06/ OP: K: 0.26</td><td>n/a</td></tr><tr><td>[85]</td><td>n/a</td><td>K: 0.71-0.88</td><td>n/a</td><td>n/a</td></tr><tr><td>[12]</td><td>ICC: 0.8</td><td>ICC: 0.8</td><td>ICC: 0.61</td><td>n/a</td></tr><tr><td>[104]</td><td>n/a</td><td>K: 0.36-0.83</td><td>n/a</td><td>n/a</td></tr><tr><td>[27]</td><td>n/a</td><td>n/a</td><td>K: 0.66-0.85</td><td>n/a</td></tr><tr><td>[111]</td><td>n/a</td><td>K: BE: 0.7-1/ CD: 0.3-0.6</td><td>n/a</td><td>n/a</td></tr><tr><td>[14]</td><td>AG: 0.91</td><td>AG: 0.89</td><td>AG: 0.65</td><td>n/a</td></tr></tbody></table>

(continued)
<table><caption>**Table 2 (Continued)**</caption><thead><tr><th>Ref.</th><th>Reliability</th><th>Validity</th><th>Feasibility</th><th>STC</th></tr></thead><tbody><tr><td>[15]</td><td>AG: 0.91</td><td>AG: 0.89</td><td>n/a</td><td>n/a</td></tr><tr><td>[105]</td><td>n/a</td><td>ICC: 0.11-1</td><td>n/a</td><td>n/a</td></tr><tr><td>[101]</td><td>n/a</td><td>K: BE: 0.42-0.47/ CD: 0.8</td><td>n/a</td><td>n/a</td></tr><tr><td>[77]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[99]</td><td>n/a</td><td>n/a</td><td>K: 0.63</td><td>n/a</td></tr><tr><td>[103]</td><td>Kr: 0.81</td><td>Kr: 0.6</td><td>Rho: 0.66</td><td>n/a</td></tr><tr><td>[46]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[123]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[124]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[125]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[126]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[127]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[128]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[129]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[130]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[131]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[132]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[133]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[134]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[135]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[136]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[137]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[138]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[139]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[47]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[140]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[36]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[141]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[142]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[143]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[144]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[53]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[145]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[38]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[28]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[146]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[29]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[147]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[148]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[149]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[150]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[31]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[151]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[152]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[48]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[49]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[40]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[44]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[153]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[154]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[155]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[156]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[157]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[158]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[159]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[160]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[161]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[162]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[163]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[79]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[164]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[51]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[165]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[166]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[42]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[167]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[168]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[169]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[170]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[171]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[172]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[88]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[82]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[84]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[57]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr></tbody></table>

(continued)
<table><caption>**Table 2 (Continued)**</caption><thead><tr><th>Ref.</th><th>Reliability</th><th>Validity</th><th>Feasibility</th><th>STC</th></tr></thead><tbody><tr><td>[15]</td><td>AG: 0.91</td><td>AG: 0.89</td><td>n/a</td><td>n/a</td></tr><tr><td>[105]</td><td>n/a</td><td>ICC: 0.11-1</td><td>n/a</td><td>n/a</td></tr><tr><td>[101]</td><td>n/a</td><td>K: BE: 0.42-0.47/ CD: 0.8</td><td>n/a</td><td>n/a</td></tr><tr><td>[77]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[99]</td><td>n/a</td><td>n/a</td><td>K: 0.63</td><td>n/a</td></tr><tr><td>[103]</td><td>Kr: 0.81</td><td>Kr: 0.6</td><td>Rho: 0.66</td><td>n/a</td></tr><tr><td>[46]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[123]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[124]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[125]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[126]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[127]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[128]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[129]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[130]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[131]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[132]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[133]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[134]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[135]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[136]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[137]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[138]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[139]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[47]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[140]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[36]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[141]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[142]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[143]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[144]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[53]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[145]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[38]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[28]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[146]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[29]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[147]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[148]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[149]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[150]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[31]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[151]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[152]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[48]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[49]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[40]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[44]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[153]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[154]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[155]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[156]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[157]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[158]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[159]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[160]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[161]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[162]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[163]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[79]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[164]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[51]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[165]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[166]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[42]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[167]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[168]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[169]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[170]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[171]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[172]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[88]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[82]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[84]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[57]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr></tbody></table>

(continued)
<table><caption>**Table 2 (Continued)**</caption><thead><tr><th>Ref.</th><th>Reliability</th><th>Validity</th><th>Feasibility</th><th>STC</th></tr></thead><tbody><tr><td>[90])</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[80]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[56]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[81]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[91]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[92]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[94]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[95]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[96]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[108]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[107]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[109]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[26]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[106]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[100]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[93]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[87]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[110]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[112]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[116]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[113]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[102]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[114]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr></tbody></table>

AC, accuracy; AG, agreement; G, Gwet's AC1; ICC, intraclass correlation; K, kappa; Kr, Krippendorff's alpha; KW, Kendall's W coefficient; N, no; n/a, not available; P, Pearson's correlation; SE, sensitivity; SP, specificity; STC, sensitivity to change; Y, yes.

[14,15,26,100–103] or by cartilage irregularity mainly of the margins in 3/24 (12.5%) studies [87,104,105] or general irregularity of the cartilage in 3/24 (12.5%) studies [27,106,107]. Nine out of the 24 studies (37.5%) only or additionally assessed cartilage thickness quantitatively [12,27,93,102,103,107–110] (Table 1).

Joints of the hands were assessed in 15 studies [12,15,77,99–106,111–114] while 9 studies [14,26,27,87,93,107,108,110,115] assessed other joints including the knee, shoulder, elbow and hip joints. Cartilage damage was rated as binary (cartilage present/absent per joint or per joint quadrant) in 12 studies [14,15,77,99–105,112,113], quantitatively by measuring cartilage thickness in 8 studies [12,27,102,103,107–110] and/or semiquantitatively in 12 studies [14,15,77,99–105,112,113]. Among the studies, which utilized a semiquantitative scoring system, 2 used a damage score combining bone erosions and cartilage loss [14,15] (Table 1).

Interobserver reliability and criterion validity expressed as comparison with other imaging methods were analyzed in 8/24 (33.3%) [12,14,15,101,103–105,111] and 5/24 (20.8%) studies [12,15,27,99,103], respectively. Five of 8 (62.5%) studies reported good to excellent agreement, including the two using the combined bone erosions and cartilage loss score [14,15]. Agreement was rated good to excellent in 1/2 (50%) studies using a binary rating (range of K: 0.6-0.7), in 3/6 (50%) studies using a semiquantitative rating (range of ICC: 0.1-1, of K: 0.3-0.8, of AG: 89-91%) and in 2/2 (100%) studies using a quantitative rating (ICC: 0.8, Krippendorff's alpha 0.6-0.81). Criterion validity was reported to be good to excellent in 1/1 (100%) study using binary scoring (K=0.7-0.9), in 3/3 (100%) studies using a semiquantitative scoring (AG: 65%, K: 0.63, rho: 0.66) and in 1/2 (50%) study using a quantitative scoring (ICC: 0.6%, rho: -0.57). One (100%) study assessing cartilage damage semiquantitatively reported no progression of cartilage damage [77]. Condylar cartilage was found to be thicker when measured by ultrasound as compared to MRI (2.1mm vs. 1.85mm, p<0.001) [27] (Table 2).

## Malalignment and ankylosis

Only a single study assessed malalignment by ultrasound [116], defined as the displacement of the temporomandibular joint disc indirectly according to the anterior capsule–condyle distances. Malalignment was scored in binary fashion (Table 1).

One study assessed ankylosis of the sternoclavicular and the manubriosternal joints [94]. Authors rated ankylosis as present or absent (binary) without providing a definition (Table 1).

## Quality assessment

All 149 studies included in the full text review underwent scoring by QUADAS-2. In each assessed term, less than 55% revealed concerns regarding applicability or bias among studies where the addressed domain was applicable. The biggest risk of bias was expressed in “flow and timing”, were 53% of the studies where this was applicable were found to have such a risk (Fig. 2).

## Discussion

One of the major advantages of ultrasound is its capability to visualize and quantify synovitis, which is predictive of structural damage. However, in contrast to the utility of ultrasound in evaluating inflammatory activity expressed by synovitis, much less has been published regarding the sonographic assessment of structural damage in RA. This SLR conducted according to the OMERACT filter 2.1, aimed to summarize all available data specifically on this latter topic.

Most included studies assessed bone erosions. A well-conducted systematic literature by the OMERACT Ultrasound WG published in 2016 included studies on erosions assessed by ultrasound until May 2014 [3]. Our review updates this previous study up to October 2020 and, in order to provide a more complete picture, also covers other elementary forms of structural damage seen in RA.

Although CR is currently used to detect erosions, ultrasound was more sensitive than CR in all studies comparing the prevalence of erosions measured by ultrasound and CR. MRI was even more sensitive than ultrasound. One possible reason for the higher sensitivity of MRI lies in the fact that it is capable of visualizing the entire joint while ultrasound only sees facets with an acoustic window. With the majority of studies utilizing MRI as the reference method, ultrasound showed a mostly good to excellent criterion validity and interobserver agreement. Furthermore, sensitivity to change was reported in the majority of studies suggesting ultrasound to be a sensitive outcome measurement tool to assess changes over time. Only five studies compared bone erosions assessed by ultrasound with CT
<table><caption>**Table 2 (Continued)**</caption><thead><tr><th>Ref.</th><th>Reliability</th><th>Validity</th><th>Feasibility</th><th>STC</th></tr></thead><tbody><tr><td>[90])</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[80]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[56]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[81]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[91]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[92]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[94]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[95]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[96]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[108]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[107]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[109]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[26]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[106]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[100]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[93]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[87]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[110]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[112]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[116]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[113]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[102]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>[114]</td><td>n/a</td><td>n/a</td><td>n/a</td><td>n/a</td></tr></tbody></table>

AC, accuracy; AG, agreement; G, Gwet's AC1; ICC, intraclass correlation; K, kappa; Kr, Krippendorff's alpha; KW, Kendall's W coefficient; N, no; n/a, not available; P, Pearson's correlation; SE, sensitivity; SP, specificity; STC, sensitivity to change; Y, yes.

[14,15,26,100–103] or by cartilage irregularity mainly of the margins in 3/24 (12.5%) studies [87,104,105] or general irregularity of the cartilage in 3/24 (12.5%) studies [27,106,107]. Nine out of the 24 studies (37.5%) only or additionally assessed cartilage thickness quantitatively [12, 27, 93, 102, 103, 107–110] (Table 1).

Joints of the hands were assessed in 15 studies [12,15,77,99–106,111–114] while 9 studies [14,26,27,87,93,107,108,110,115] assessed other joints including the knee, shoulder, elbow and hip joints. Cartilage damage was rated as binary (cartilage present/absent per joint or per joint quadrant) in 12 studies [14,15,77,99–105,112,113], quantitatively by measuring cartilage thickness in 8 studies [12,27,102,103,107–110] and/or semiquantitatively in 12 studies [14,15,77,99–105,112,113]. Among the studies, which utilized a semiquantitative scoring system, 2 used a damage score combining bone erosions and cartilage loss [14,15] (Table 1).

Interobserver reliability and criterion validity expressed as comparison with other imaging methods were analyzed in 8/24 (33.3%) [12,14,15,101,103–105,111] and 5/24 (20.8%) studies [12,15,27,99,103], respectively. Five of 8 (62.5%) studies reported good to excellent agreement, including the two using the combined bone erosions and cartilage loss score [14,15]. Agreement was rated good to excellent in 1/2 (50%) studies using a binary rating (range of K: 0.6-0.7), in 3/6 (50%) studies using a semiquantitative rating (range of ICC: 0.1-1, of K: 0.3-0.8, of AG: 89-91%) and in 2/2 (100%) studies using a quantitative rating (ICC: 0.8, Krippendorff's alpha 0.6-0.81). Criterion validity was reported to be good to excellent in 1/1 (100%) study using binary scoring (K=0.7-0.9), in 3/3 (100%) studies using a semiquantitative scoring (AG: 65%, K: 0.63, rho: 0.66) and in 1/2 (50%) study using a quantitative scoring (ICC: 0.6%, rho: -0.57). One (100%) study assessing cartilage damage semiquantitatively reported no progression of cartilage damage [77]. Condylar cartilage was found to be thicker when measured by ultrasound as compared to MRI (2.1mm vs. 1.85mm, p<0.001) [27] (Table 2).

## Malalignment and ankylosis

Only a single study assessed malalignment by ultrasound [116], defined as the displacement of the temporomandibular joint disc indirectly according to the anterior capsule–condyle distances. Malalignment was scored in binary fashion (Table 1).

One study assessed ankylosis of the sternoclavicular and the manubriosternal joints [94]. Authors rated ankylosis as present or absent (binary) without providing a definition (Table 1).

## Quality assessment

All 149 studies included in the full text review underwent scoring by QUADAS-2. In each assessed term, less than 55% revealed concerns regarding applicability or bias among studies where the addressed domain was applicable. The biggest risk of bias was expressed in “flow and timing”, were 53% of the studies where this was applicable were found to have such a risk (Fig. 2).

## Discussion

One of the major advantages of ultrasound is its capability to visualize and quantify synovitis, which is predictive of structural damage. However, in contrast to the utility of ultrasound in evaluating inflammatory activity expressed by synovitis, much less has been published regarding the sonographic assessment of structural damage in RA. This SLR conducted according to the OMERACT filter 2.1, aimed to summarize all available data specifically on this latter topic.

Most included studies assessed bone erosions. A well-conducted systematic literature by the OMERACT Ultrasound WG published in 2016 included studies on erosions assessed by ultrasound until May 2014 [3]. Our review updates this previous study up to October 2020 and, in order to provide a more complete picture, also covers other elementary forms of structural damage seen in RA.

Although CR is currently used to detect erosions, ultrasound was more sensitive than CR in all studies comparing the prevalence of erosions measured by ultrasound and CR. MRI was even more sensitive than ultrasound. One possible reason for the higher sensitivity of MRI lies in the fact that it is capable of visualizing the entire joint while ultrasound only sees facets with an acoustic window. With the majority of studies utilizing MRI as the reference method, ultrasound showed a mostly good to excellent criterion validity and interobserver agreement. Furthermore, sensitivity to change was reported in the majority of studies suggesting ultrasound to be a sensitive outcome measurement tool to assess changes over time. Only five studies compared bone erosions assessed by ultrasound with CT
<figure><img src="image_2.png" /><figcaption>**Fig. 2.** Results of the quality assessment tool for diagnostic accuracy studies (QUADAS-2) for all studies included in the systematic literature review (n=149); concerns reg applicability: concerns regarding applicability; ref. standard: reference standard.</figcaption></figure>

[39,60,61,67,146]. Three studies [46,60,61] considered CT as the gold standard to calculate sensitivity and specificity of ultrasound to detect erosions. One study compared the frequency of erosions detected by ultrasound and CT [146] and detected more erosions by ultrasound.

Included studies which did not show changes of erosions had follow-up times of 22 weeks [71], 6 months [34,75] and 12 months [25,32,60,77] these time periods however might be too short to detect differences.

Most radiographic scores including erosions use semiquantitative scores [173]. While the majority of the ultrasound studies included in this SLR scored erosions in binary fashion as present or absent on patient or joint level or in each joint quadrant, approximately a third of the studies used a semiquantitative scoring method. This method was based either on the number of erosions per joint or the size of the erosions or by a combination thereof. Counting erosions has the disadvantage that in case two small erosions merge into one big erosion, progression might be scored as improvement. In contrast, additional small erosions may not be taken into account if only the largest erosion is counted. Thus, it seems optimal to consider both size and number of erosions.

Cartilage damage was assessed in 19 studies. It was rated mostly in binary fashion (cartilage damage present/ absent per joint or joint quadrant), quantitatively by measuring cartilage damage or semiquantitatively. One study compared cartilage thickness measured by ultrasound with the actual thickness subsequently measured in cadaveric specimen. Another study measured distal femoral cartilage thickness. Generally, intra- and interobserver reliability was moderate to excellent in the included studies. Compared to measuring the actual cartilage thickness, the binary or semiquantitative score is independent of the patients demographic (age, gender, etc.) and physical (height, weight, etc.) characteristics as healthy cartilage thickness might differ from person to person based on these factors. A recently published semiquantitative ultrasound scoring system for cartilage damage by the OMERACT Ultrasound WG was shown to be reliable in web-based and patient-based exercises and has already been validated in an independent patient cohort [2,147].

Enthesophytes are typical manifestations of psoriatic arthritis and osteoarthritis [174]. Three studies assessed enthesophytes in patients with psoriatic arthritis and those with RA. The studies reported overall good interobserver agreement, although it should be pointed out that enthesophytes were found to be quite rare in RA.

Malalignment or subluxation is widely accepted as clinical feature of structural damage in RA and is part of several radiographic

damage scores [175,176]. However, only one included study assessed malalignment by ultrasound, highlighting a need for future studies in this area.

Although theoretically all synovial joints can be affected in RA, screening all joints by ultrasound for damage is not feasible. The detection of damage is important for diagnosis, evaluation of therapy as well as for its predictive value. Target joints for assessment of structural damage should be those that are affected often and early in the course of the disease. Small joints of the hands and feet are affected in the majority of patients with RA and studies showed that they are predictive of composite scores including both small and large joints. Furthermore, MTP joints have been shown to be the site where erosions initially develop [177]. Thus, most CR-based damage scores include hands and feet [173,175–177]. Similarly, most included ultrasound studies assessed joints of the hand and/or MTPs. Only few studies included large joints, which limits the generalizability of this review to all joints. The assessment of small joints of the hands and feet however seems feasible and practical considering they are early and frequent locations for structural damage. RA is a symmetrical disease. All but 22 studies assessed joints bilaterally. In several studies, more erosions with faster progression were found on the dominant hand compared to the non-dominant hand [178,179]. In contrast, synovitis is not thought to develop more often on the dominant hand [180]. Whether assessing structural joint damage by ultrasound on one side only is sufficient, will have to be addressed in future studies. In order to correctly interpret structural damage assessed by ultrasound, the recognition of the frequency and characteristics of these features in healthy individuals is important. Due to the fact that ultrasound seems to be more sensitive than CR, semiquantitatively detected damage should be interpreted with particular caution. Several studies found ultrasound signs of synovitis as well as structural damage in healthy individuals [181–183].

While this review aims to cover the elementary forms of structural damage seen in RA, damage to periarticular and articular soft tissues, such as ligaments, tendons and muscles were not included, which is a limitation. We also did not include joint space narrowing, since this mainly corresponds to cartilage loss and also because ultrasound is not considered to be an ideal modality for its assessment.

In conclusion, the findings of this systemic literature review suggest that ultrasound is a valid and reliable outcome measurement tool to detect joint damage, particularly in small joints of the hands and feet where validated definitions and scoring system exist. Erosions and cartilage damage were the most often assessed and most prevalent features. The development of a composite or combined
<figure><img src="image_3.png" /><figcaption>**Fig. 2.** Results of the quality assessment tool for diagnostic accuracy studies (QUADAS-2) for all studies included in the systematic literature review (n=149); concerns reg applicability: concerns regarding applicability; ref. standard: reference standard.</figcaption></figure>

[39,60,61,67,146]. Three studies [46,60,61] considered CT as the gold standard to calculate sensitivity and specificity of ultrasound to detect erosions. One study compared the frequency of erosions detected by ultrasound and CT [146] and detected more erosions by ultrasound.

Included studies which did not show changes of erosions had follow-up times of 22 weeks [71], 6 months [34,75] and 12 months [25,32,60,77] these time periods however might be too short to detect differences.

Most radiographic scores including erosions use semiquantitative scores [173]. While the majority of the ultrasound studies included in this SLR scored erosions in binary fashion as present or absent on patient or joint level or in each joint quadrant, approximately a third of the studies used a semiquantitative scoring method. This method was based either on the number of erosions per joint or the size of the erosions or by a combination thereof. Counting erosions has the disadvantage that in case two small erosions merge into one big erosion, progression might be scored as improvement. In contrast, additional small erosions may not be taken into account if only the largest erosion is counted. Thus, it seems optimal to consider both size and number of erosions.

Cartilage damage was assessed in 19 studies. It was rated mostly in binary fashion (cartilage damage present/ absent per joint or joint quadrant), quantitatively by measuring cartilage damage or semiquantitatively. One study compared cartilage thickness measured by ultrasound with the actual thickness subsequently measured in cadaveric specimen. Another study measured distal femoral cartilage thickness. Generally, intra- and interobserver reliability was moderate to excellent in the included studies. Compared to measuring the actual cartilage thickness, the binary or semiquantitative score is independent of the patients demographic (age, gender, etc.) and physical (height, weight, etc.) characteristics as healthy cartilage thickness might differ from person to person based on these factors. A recently published semiquantitative ultrasound scoring system for cartilage damage by the OMERACT Ultrasound WG was shown to be reliable in web-based and patient-based exercises and has already been validated in an independent patient cohort [2,147].

Enthesophytes are typical manifestations of psoriatic arthritis and osteoarthritis [174]. Three studies assessed enthesophytes in patients with psoriatic arthritis and those with RA. The studies reported overall good interobserver agreement, although it should be pointed out that enthesophytes were found to be quite rare in RA.

Malalignment or subluxation is widely accepted as clinical feature of structural damage in RA and is part of several radiographic

damage scores [175,176]. However, only one included study assessed malalignment by ultrasound, highlighting a need for future studies in this area.

Although theoretically all synovial joints can be affected in RA, screening all joints by ultrasound for damage is not feasible. The detection of damage is important for diagnosis, evaluation of therapy as well as for its predictive value. Target joints for assessment of structural damage should be those that are affected often and early in the course of the disease. Small joints of the hands and feet are affected in the majority of patients with RA and studies showed that they are predictive of composite scores including both small and large joints. Furthermore, MTP joints have been shown to be the site where erosions initially develop [177]. Thus, most CR-based damage scores include hands and feet [173,175–177]. Similarly, most included ultrasound studies assessed joints of the hand and/or MTPs. Only few studies included large joints, which limits the generalizability of this review to all joints. The assessment of small joints of the hands and feet however seems feasible and practical considering they are early and frequent locations for structural damage. RA is a symmetrical disease. All but 22 studies assessed joints bilaterally. In several studies, more erosions with faster progression were found on the dominant hand compared to the non-dominant hand [178,179]. In contrast, synovitis is not thought to develop more often on the dominant hand [180]. Whether assessing structural joint damage by ultrasound on one side only is sufficient, will have to be addressed in future studies. In order to correctly interpret structural damage assessed by ultrasound, the recognition of the frequency and characteristics of these features in healthy individuals is important. Due to the fact that ultrasound seems to be more sensitive than CR, semiquantitatively detected damage should be interpreted with particular caution. Several studies found ultrasound signs of synovitis as well as structural damage in healthy individuals [181–183].

While this review aims to cover the elementary forms of structural damage seen in RA, damage to periarticular and articular soft tissues, such as ligaments, tendons and muscles were not included, which is a limitation. We also did not include joint space narrowing, since this mainly corresponds to cartilage loss and also because ultrasound is not considered to be an ideal modality for its assessment.

In conclusion, the findings of this systemic literature review suggest that ultrasound is a valid and reliable outcome measurement tool to detect joint damage, particularly in small joints of the hands and feet where validated definitions and scoring system exist. Erosions and cartilage damage were the most often assessed and most prevalent features. The development of a composite or combined
ultrasound damage score and the determination of target joints are
tasks for future studies. These should ideally consist of consensus def-
initions and scanning characteristics of elementary lesions of struc-
tural damage, the scoring thereof, followed by validation of such
lesions and scoring systems, first in web-based and patient-based
exercises, and finally in clinical studies.

Declaration of Competing Interest

None

**Supplementary materials**

Supplementary material associated with this article can be found
in the online version at doi:10.1016/j.tranom.2021.101079.

**References**

[1] Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nat Rev Dis Primers 2018;4:18001.

[2] Mandl P, Studenic P, Filippucci E, Bachta A, Backhaus M, Bong D, et al. Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis. Rheumatology (Oxford) 2019;58(10):1802-11.

[3] Szkudlarek M, Tersley L, Wakefield RJ, Backhaus M, Balint PV, Bruyn GA, et al. Summary findings of a systematic literature review of the ultrasound assessment of bone erosions in rheumatoid arthritis. J Rheumatol 2016;43(1):12-21.

[4] Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham 3rd CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69(9):1580-8.

[5] Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977;18(4):481-91.

[6] Apfelberg DB, Maser MR, Lash H, Kaye RL, Britton MC, Bobrove A. Rheumatoid hand deformities: pathophysiology and treatment. West J Med 1978;129 (4):267-72.

[7] Okumura N, Kawasaki T, Kubo M, Yayama T, Mimura T, Kumagai K, et al. Effects of malalignment and disease activity on osteophyte formation in knees of rheumatoid arthritis patients. J Orthop Surg (Hong Kong). 2020;28 (1):2309499020911852.

[8] Stach CM, Bauerle M, Englbrecht M, Kronke G, Engelke K, Manger B, et al. Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by high-resolution computed tomography. Arthritis Rheum 2010;62 (2):330-9.

[9] Figueiredo CP, Simon D, Englbrecht M, Haschka J, Kleyer A, Bayat S, et al. Quantified and impact of secondary osteoarthritis in patients with anti-citrullinated protein antibody-positive rheumatoid arthritis. Arthritis Rheumatol 2016;68(9):2114-21.

[10] Sharp JT, Lidsky MD, Collins LC, Moreland J. Methods of scoring the progression of radiologic changes in rheumatoid arthritis. Correlation of radiologic, clinical and laboratory abnormalities. Arthritis Rheum 1971;14(6):706-20.

[11] van der Heijde DM. Radiographic imaging: the 'gold standard' for assessment of disease progression in rheumatoid arthritis. Rheumatology (Oxford) 2000;39 (1):9–16 Suppl.

[12] Mandl P, Supp G, Baksa G, Radner H, Studenic P, Gyebnar J, et al. Relationship between radiographic joint space narrowing, sonographic cartilage thickness and anatomy in rheumatoid arthritis and control joints. Ann Rheumatic Dis 2015;74(11):2022-7.

[13] Dohn UM, Ejbjerg BJ, Court-Payen M, Hasselquist M, Narvestad E, Szkudlarek M, et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther 2006;8(4):R110.

[14] Lerch K, Borisch N, Paetzel C, Grifka J, Hartung W. Sonographic evaluation of the elbow in rheumatoid arthritis: a classification of joint destruction. Ultrasound Med Biol 2003;29(8):1131-5.

[15] Lerch K, Borisch N, Paetzel C, Grifka J, Hartung W. Proposal for a sonographic classification of target joints in rheumatoid arthritis. Rheumatol Int 2005;25 (3):215-9.

[16] Ceccarelli F, Perricone C, Fabris M, Alessandri C, Iagnocco A, Fabro C, et al. Transforming growth factor β 869C/T and interleukin 6 -174G/C polymorphisms relate to the severity and progression of bone-erosive damage detected by ultrasound in rheumatoid arthritis. Arthritis Res Therapy 2011;13(4).

[17] Macchioni P, Magnani M, Mulè R, Galletti S, Catanoso M, Pignotti E, et al. Ultrasonographic predictors for the development of joint damage in rheumatoid arthritis patients: a single joint prospective study. Clin Exp Rheumatol 2013;31 (1):08-17.

[18] Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Østergaard M. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheumatism 2004;50(7):2103-12.

[19] Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Lib Assoc 2018;106(4):420-31.

[20] Joshua F, Lassere M, Bruyn GA, Szkudlarek M, Naredo E, Schmidt WA, et al. Summary findings of a systematic review of the ultrasound assessment of synovitis. J Rheumatol 2007;34(4):839-47.

[21] Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155(8):529-36.

[22] Torp-Pedersen S, Bartels EM, Wilhjelm J, Bliddal H. Articular cartilage thickness measured with US is not as easy as it appears: a systematic review of measurement techniques and image interpretation. Ultraschall Med 2011;32(1):54-61.

[23] Ohrndorf S, Messerschmidt J, Reiche BE, Burmester GR, Backhaus M. Evaluation of a new erosion score by musculoskeletal ultrasound in patients with rheumatoid arthritis: is US ready for a new erosion score? Clin Rheumatol 2014;33 (9):1255-62.

[24] Schmidt WA, Schicke B, Ostendorf B, Scherer A, Krause A, Walther M. Low-field MRI versus ultrasound: which is more sensitive in detecting inflammation and bone damage in MCP and MTP joints in mild or moderate rheumatoid arthritis? Clin Exp Rheumatol 2013;31(1):91-6.

[25] Naredo E, Acebes C, Brito E, De Agustín JJ, De Miguel E, Mayordomo L, et al. Three-dimensional volumetric ultrasound: a valid method for blinded assessment of response to therapy in rheumatoid arthritis. J Rheumatol 2013;40 (3):253-60.

[26] Sanja MR, Mirjana ZS. Ultrasonographic study of the painful shoulder in patients with rheumatoid arthritis and patients with degenerative shoulder disease. Acta Rheumatol Port 2010;35(1):50-8.

[27] Yücesoy C, Genc C, Bal Ajda, Keyik B, Öztürk E, Tüzün M, Çakçı A, Hekimoğlu B. Ultrasonographic assessment of knee in patients with rheumatoid arthritis: is it an effective imaging method for initial evaluation? Arch Rheumatol 2021;26 (2):120-6.

[28] Backhaus TM, Ohrndorf S, Kellner H, Strunk J, Hartung W, Sattler H, et al. The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy. Ann Rheumatic Dis 2013;72(7):1163-9.

[29] Soliman E. Musculoskeletal ultrasound in first degree relatives of rheumatoid arthritis patients. Ann Rheumatic Dis 2018;77:1175.

[30] Harman H, Tekeoğlu I, Sağ MS, Harman S. Diagnostic value of musculoskeletal ultrasound in newly diagnosed rheumatoid arthritis patients. Turki Fiziksel Tip ve Rehabilitasyon Dergisi 2015;61(4):326-32.

[31] Ottaviani S, Gill G, Palazzo E, Meyer O, Dieudé P. Ultrasonography of shoulders in spondyloarthritis and rheumatoid arthritis: a case-control study. Joint Bone Spine 2014;81(3):247-9.

[32] Ohrndorf S, Halbauer B, Martus P, Reiche B, Backhaus TM, Burmester GR, et al. Detailed joint region analysis of the 7-joint ultrasound score: evaluation of an arthritis patient cohort over one year. Int J Rheumatol 2013:2013.

[33] Wakefield RJ, Gibbon WW, Conaghan PG, O'Connor P, McGonagle D, Pease C, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheumatism 2000;43(12):2762-70.

[34] Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Care Res 2009;61(9):1194-201.

[35] Hammer HB, Haavardsholm EA, Bøyesen P, Kvien TK. Bone erosions at the distal ulna detected by ultrasonography are associated with structural damage assessed by conventional radiography and MRI: a study of patients with recent onset rheumatoid arthritis. Rheumatology 2009;48(12):1530-2.

[36] Menshikova I, Dzhenzhera N, Pak Y, Kolosova I. Comparison of efficacy of tofacitinib vs etanercept treatment in rheumatoid arthritis patients with high activity disease by ultrasound evaluation with power doppler (1 year treatment period). Ann Rheum Dis 2018;77:976.

[37] Backhaus M, Burmester GR, Sandrock D, Loreck D, Hess D, Scholz A, et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 2002;61 (10):895-904.

[38] Broll M, Albrecht K, Tarner I, Muller-Ladner U, Strunk J. Sensitivity and specificity of ultrasonography and low-field magnetic resonance imaging for diagnosing arthritis. Clin Exp Rheumatol 2012;30(4):543-7.

[39] Peluso G, Bosello SL, Gremese E, Mirone L, Di Gregorio F, Di Molfetta V, et al. Detection of bone erosions in early rheumatoid arthritis: 3D ultrasonography versus computed tomography. Clin Rheumatol 2015;34(7):1181-6.

[40] Reiche BE, Ohrndorf S, Feist E, Messerschmidt J, Burmester GR, Backhaus M. Usefulness of power Doppler ultrasound for prediction of re-therapy with rituximab in rheumatoid arthritis: a prospective study of longstanding rheumatoid arthritis patients. Arthritis Care Res 2014;66(2):204-16.

[41] Hoving JL, Buchbinder R, Hall S, Lawler G, Coombs P, McNealy S, et al. A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol 2004;31(4):663-75.

[42] Tan YK, Thumboo J. High feasibility and acceptance of a musculoskeletal ultrasound program to improve dmards adherence in rheumatoid arthritis. Ann Rheum Dis 2019;78:1369.

[43] Bajaj S, Lopez-Ben R, Oster R, Alarcón GS. Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: a prospective longitudinal study. Skeletal Radiol 2007;36(2):123-8.

[44] Funck-Brentano T, Etchepare F, Joulin SJ, Gandjbakch F, Pensec VD, Cyteval C, et al. Benefits of ultrasonography in the management of early arthritis: a cross-
ultrasound damage score and the determination of target joints are
tasks for future studies. These should ideally consist of consensus def-
initions and scanning characteristics of elementary lesions of struc-
tural damage, the scoring thereof, followed by validation of such
lesions and scoring systems, first in web-based and patient-based
exercises, and finally in clinical studies.

Declaration of Competing Interest

None

**Supplementary materials**

Supplementary material associated with this article can be found
in the online version at doi:10.1016/j.tranom.2021.101079.

**References**

[1] Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nat Rev Dis Primers 2018;4:18001.

[2] Mandl P, Studenic P, Filippucci E, Bachta A, Backhaus M, Bong D, et al. Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis. Rheumatology (Oxford) 2019;58(10):1802-11.

[3] Szkudlarek M, Tersley L, Wakefield RJ, Backhaus M, Balint PV, Bruyn GA, et al. Summary findings of a systematic literature review of the ultrasound assessment of bone erosions in rheumatoid arthritis. J Rheumatol 2016;43(1):12-21.

[4] Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham 3rd CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69(9):1580-8.

[5] Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977;18(4):481-91.

[6] Apfelberg DB, Maser MR, Lash H, Kaye RL, Britton MC, Bobrove A. Rheumatoid hand deformities: pathophysiology and treatment. West J Med 1978;129 (4):267-72.

[7] Okumura N, Kawasaki T, Kubo M, Yayama T, Mimura T, Kumagai K, et al. Effects of malalignment and disease activity on osteophyte formation in knees of rheumatoid arthritis patients. J Orthop Surg (Hong Kong). 2020;28 (1):2309499020911852.

[8] Stach CM, Bauerle M, Englbrecht M, Kronke G, Engelke K, Manger B, et al. Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by high-resolution computed tomography. Arthritis Rheum 2010;62 (2):330-9.

[9] Figueiredo CP, Simon D, Englbrecht M, Haschka J, Kleyer A, Bayat S, et al. Quantified and impact of secondary osteoarthritis in patients with anti-citrullinated protein antibody-positive rheumatoid arthritis. Arthritis Rheumatol 2016;68(9):2114-21.

[10] Sharp JT, Lidsky MD, Collins LC, Moreland J. Methods of scoring the progression of radiologic changes in rheumatoid arthritis. Correlation of radiologic, clinical and laboratory abnormalities. Arthritis Rheum 1971;14(6):706-20.

[11] van der Heijde DM. Radiographic imaging: the 'gold standard' for assessment of disease progression in rheumatoid arthritis. Rheumatology (Oxford) 2000;39 (1):9-16 Suppl.

[12] Mandl P, Supp G, Baksa G, Radner H, Studenic P, Gyebnar J, et al. Relationship between radiographic joint space narrowing, sonographic cartilage thickness and anatomy in rheumatoid arthritis and control joints. Ann Rheumatic Dis 2015;74(11):2022-7.

[13] Dohn UM, Ejbjerg BJ, Court-Payen M, Hasselquist M, Narvestad E, Szkudlarek M, et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther 2006;8(4):R110.

[14] Lerch K, Borisch N, Paetzel C, Grifka J, Hartung W. Sonographic evaluation of the elbow in rheumatoid arthritis: a classification of joint destruction. Ultrasound Med Biol 2003;29(8):1131-5.

[15] Lerch K, Borisch N, Paetzel C, Grifka J, Hartung W. Proposal for a sonographic classification of target joints in rheumatoid arthritis. Rheumatol Int 2005;25 (3):215-9.

[16] Ceccarelli F, Perricone C, Fabris M, Alessandri C, Iagnocco A, Fabro C, et al. Transforming growth factor β 869C/T and interleukin 6 -174G/C polymorphisms relate to the severity and progression of bone-erosive damage detected by ultrasound in rheumatoid arthritis. Arthritis Res Therapy 2011;13(4).

[17] Macchioni P, Magnani M, Mulè R, Galletti S, Catanoso M, Pignotti E, et al. Ultrasonographic predictors for the development of joint damage in rheumatoid arthritis patients: a single joint prospective study. Clin Exp Rheumatol 2013;31 (1):08-17.

[18] Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Østergaard M. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheumatism 2004;50(7):2103-12.

[19] Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Lib Assoc 2018;106(4):420-31.

[20] Joshua F, Lassere M, Bruyn GA, Szkudlarek M, Naredo E, Schmidt WA, et al. Summary findings of a systematic review of the ultrasound assessment of synovitis. J Rheumatol 2007;34(4):839-47.

[21] Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155(8):529-36.

[22] Torp-Pedersen S, Bartels EM, Wilhjelm J, Bliddal H. Articular cartilage thickness measured with US is not as easy as it appears: a systematic review of measurement techniques and image interpretation. Ultraschall Med 2011;32(1):54-61.

[23] Ohrndorf S, Messerschmidt J, Reiche BE, Burmester GR, Backhaus M. Evaluation of a new erosion score by musculoskeletal ultrasound in patients with rheumatoid arthritis: is US ready for a new erosion score? Clin Rheumatol 2014;33 (9):1255-62.

[24] Schmidt WA, Schicke B, Ostendorf B, Scherer A, Krause A, Walther M. Low-field MRI versus ultrasound: which is more sensitive in detecting inflammation and bone damage in MCP and MTP joints in mild or moderate rheumatoid arthritis? Clin Exp Rheumatol 2013;31(1):91-6.

[25] Naredo E, Acebes C, Brito E, De Agustín JJ, De Miguel E, Mayordomo L, et al. Three-dimensional volumetric ultrasound: a valid method for blinded assessment of response to therapy in rheumatoid arthritis. J Rheumatol 2013;40 (3):253-60.

[26] Sanja MR, Mirjana ZS. Ultrasonographic study of the painful shoulder in patients with rheumatoid arthritis and patients with degenerative shoulder disease. Acta Rheumatol Port 2010;35(1):50-8.

[27] Yücesoy C, Genc C, Bal Ajda, Keyik B, Öztürk E, Tüzün M, Çakçı A, Hekimoğlu B. Ultrasonographic assessment of knee in patients with rheumatoid arthritis: is it an effective imaging method for initial evaluation? Arch Rheumatol 2021;26 (2):120-6.

[28] Backhaus TM, Ohrndorf S, Kellner H, Strunk J, Hartung W, Sattler H, et al. The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy. Ann Rheumatic Dis 2013;72(7):1163-9.

[29] Soliman E. Musculoskeletal ultrasound in first degree relatives of rheumatoid arthritis patients. Ann Rheumatic Dis 2018;77:1175.

[30] Harman H, Tekeoğlu I, Sağ MS, Harman S. Diagnostic value of musculoskeletal ultrasound in newly diagnosed rheumatoid arthritis patients. Turki Fiziksel Tip ve Rehabilitasyon Dergisi 2015;61(4):326-32.

[31] Ottaviani S, Gill G, Palazzo E, Meyer O, Dieudé P. Ultrasonography of shoulders in spondyloarthritis and rheumatoid arthritis: a case-control study. Joint Bone Spine 2014;81(3):247-9.

[32] Ohrndorf S, Halbauer B, Martus P, Reiche B, Backhaus TM, Burmester GR, et al. Detailed joint region analysis of the 7-joint ultrasound score: evaluation of an arthritis patient cohort over one year. Int J Rheumatol 2013:2013.

[33] Wakefield RJ, Gibbon WW, Conaghan PG, O'Connor P, McGonagle D, Pease C, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheumatism 2000;43(12):2762-70.

[34] Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Care Res 2009;61(9):1194-201.

[35] Hammer HB, Haavardsholm EA, Bøyesen P, Kvien TK. Bone erosions at the distal ulna detected by ultrasonography are associated with structural damage assessed by conventional radiography and MRI: a study of patients with recent onset rheumatoid arthritis. Rheumatology 2009;48(12):1530-2.

[36] Menshikova I, Dzhenzhera N, Pak Y, Kolosova I. Comparison of efficacy of tofacitinib vs etanercept treatment in rheumatoid arthritis patients with high activity disease by ultrasound evaluation with power doppler (1 year treatment period). Ann Rheum Dis 2018;77:976.

[37] Backhaus M, Burmester GR, Sandrock D, Loreck D, Hess D, Scholz A, et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 2002;61 (10):895-904.

[38] Broll M, Albrecht K, Tarner I, Muller-Ladner U, Strunk J. Sensitivity and specificity of ultrasonography and low-field magnetic resonance imaging for diagnosing arthritis. Clin Exp Rheumatol 2012;30(4):543-7.

[39] Peluso G, Bosello SL, Gremese E, Mirone L, Di Gregorio F, Di Molfetta V, et al. Detection of bone erosions in early rheumatoid arthritis: 3D ultrasonography versus computed tomography. Clin Rheumatol 2015;34(7):1181-6.

[40] Reiche BE, Ohrndorf S, Feist E, Messerschmidt J, Burmester GR, Backhaus M. Usefulness of power Doppler ultrasound for prediction of re-therapy with rituximab in rheumatoid arthritis: a prospective study of longstanding rheumatoid arthritis patients. Arthritis Care Res 2014;66(2):204-16.

[41] Hoving JL, Buchbinder R, Hall S, Lawler G, Coombs P, McNealy S, et al. A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol 2004;31(4):663-75.

[42] Tan YK, Thumboo J. High feasibility and acceptance of a musculoskeletal ultrasound program to improve dmards adherence in rheumatoid arthritis. Ann Rheum Dis 2019;78:1369.

[43] Bajaj S, Lopez-Ben R, Oster R, Alarcón GS. Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: a prospective longitudinal study. Skeletal Radiol 2007;36(2):123-8.

[44] Funck-Brentano T, Etchepare F, Joulin SJ, Gandjbakch F, Pensec VD, Cyteval C, et al. Benefits of ultrasonography in the management of early arthritis: a cross-
sectional study of baseline data from the ESPOIR cohort. Rheumatology 2009;48 (12):1515-9.

[45] Ventura-Rios L, Hernandez-Diaz C, Sanchez-Brinas G, Madrigal-Santillan E. Morales-Gonzalez JA, Pineda C. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol 2016;35(9):2269-76.

[46] Acebes C, McKay N, Ciechomska A, Alcorn N, Harvie JP, Robson B, et al. Level of agreement between three-dimensional volumetric ultrasound and real-time conventional ultrasound in the assessment of synovitis, tenosynovitis and erosions in rheumatoid arthritis patients. Rheumatol Int 2017;37(2):197-205.

[47] Quintero M, Sánchez R, Arapé R, Sosa A, Escobar H, Rodríguez V, et al. Study of bone erosions of the metacarpophalangeal joints of patients with early rheumatoid arthritis by conventional radiology and ultrasound. J Clin Rheumatol 2018;24(3):S78-S9.

[48] Baan H, Drossaers-Bakker W, Dubbeldam R, Van De Laar M. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol 2011;30(11):1475-9.

[49] Vasanth LC, Foo LF, Potter HG, Adler RS, Finzel KC, Pavlov H, et al. Using magnetic resonance angiography to measure abnormal synovial blood vessels in early inflammatory arthritis: a new imaging biomarker? J Rheumatol 2010;37 (6):1129-35.

[50] Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, et al. Optimization of ultrasonographic examination for the diagnosis of erosive rheumatoid Arthritis in comparison to erosive hand Osteoarthritis. Eur J Radiol 2019;118:10-8.

[51] Nakabo S, Tsuji Y, Inagaki M, Tsuji H, Nakajima T, Murakami K, et al. Severe joint deformity and patient global assessment of disease are associated with discrepancies between sonographic and clinical remission: a cross-sectional study of rheumatoid arthritis patients. Modern Rheumatol 2020:1-9.

[52] Ellegaard K, Bliddal H, Møller Døhn U, Henriksen M, Boesen M, Bouertin R, et al. Validity and reliability of 3D US for the detection of erosions in patients with rheumatoid arthritis using MRI as the gold standard. Ultraschall in der Medizin (Stuttgart, Germany) 1980;2014;35(2):137-41.

[53] Tamas MM, Filippucci E, Becciolini A, Gutierrez M, Di Geso L, Bonfiglioli K, et al. Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease. Rheumatology (Oxford) 2014;53(6):1100-7.

[54] Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005;32(12):2485-7.

[55] Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48(4):955-62.

[56] Kunkel GA, Cannon GW, Clegg DO. Combined structural and synovial assessment for Improved ultrasound Discrimination of rheumatoid, osteoarthritic, and normal joints: a pilot study. Open Rheumatol J 2012;6(1):199-206.

[57] Abaza N, Gadallah N, Elhosseiny M, El-Bakry SA, Yourys S. Verification of an ultrasonographic scoring system in discriminating rheumatoid from osteoarthritic and normal joints in an Egyptian cohort. Ann Rheum Dis 2015;74:1261.

[58] Lerch K, Herold T, Borisch N, Grifka J. Imaging in rheumatoid arthritis of the elbow. Die Bildgebung beim krankenseitigen Ellenbogen 2003;32(8):691-8.

[59] Amin MF, Ismail FM, El Shereef RR. The role of ultrasonography in early detection and monitoring of shoulder erosions, and disease activity in rheumatoid arthritis patients; comparison with MRI examination. Acad Radiol 2012;19 (6):693-700.

[60] Dohn UM, Ejberg B, Boonen A, Hetland ML, Hansen MS, Knudsen LS, et al. No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. Ann Rheum Dis 2011;70(2):252-8.

[61] Dohn UM, Terslev L, Szkudlarek M, Hansen MS, Hetland ML, Hansen A, et al. Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT. Ann Rheum Dis 2013;72(4):530-4.

[62] Saran S, Bagarhatta M, Saigal R. Diagnostic accuracy of ultrasonography in detection of destructive changes in small joints of hands in patients of rheumatoid arthritis: a comparison with magnetic resonance imaging. J Assoc Phys India 2016;64(11):26-30.

[63] Szkudlarek M, Klarlund M, Navarsted E, Court-Payen M, Strandberg C, Jensen KE, et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther 2006;8(2):R52.

[64] Hetta WM, Sharara SM, Gouda GA. Role of magnetic resonance imaging and ultrasonography in diagnosis and followup rheumatoid arthritis in hand and wrist joints. Egypt J Radiol Nucl Med 2018;49(4):1043-51.

[65] Falsetti P, Frediani B, Fioravanti A, Acciai C, Baldi F, Filippou G, et al. Sonographic study of calcaneal entheses in erosive osteoarthritis, nodal osteoarthritis, rheumatoid arthritis and psoriatic arthritis. Scand J Rheumatol 2003;32(4):229-34.

[66] Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48(4):955-62.

[67] Finzel S, Aegerter P, Schett G, D'Agostino MA. Identification, localization and differentiation of erosions and physiological bone channels by ultrasound in rheumatoid arthritis patients. Rheumatology (Oxford, England) 2020.

[68] Grosse J, Allado E, Albuisson É, Pierreisnard A, Couderc M, Chary-Valckenaere I, et al. The USSe (UltraSound Score for Erosions) in the evaluation of bone erosions in RA compared to the SHSe (Van der Heijde-modified Sharp score for erosions). The J Rheumatol 2020.

[69] Serban O, Fodor D, Papp I, Micu MC, Duma DG, Csatuk C, et al. Reasons for discor- dances between ultrasonography and magnetic resonance imaging in the evalu- ation of the ankle, hindfoot and heel of the patients with rheumatoid arthritis. Med Ultrasonogr 2019;21(4):405-13.

[70] Zou H, Beattie KA, Allen M, Ioannidis G, Larché MJ. Ultrasonography supplements clinical exam to improve early rheumatoid arthritis disease activity monitoring in metatarsophalangeal joints. Clin Rheumatol 2020;39(5):1483-91.

[71] Leng X, Xiao W, Xu Z, Zhu X, Liu Y, Zhao D, et al. Ultrasound7 versus ultrasound12 in monitoring the response to infliximab in patients with rheumatoid arthritis. Clin Rheumatol 2016;35(3):587-94.

[72] Reynolds PPM, Heron C, Pilcher J, Kiely PDW. Prediction of erosion progression using ultrasound in established rheumatoid arthritis: a 2-year follow-up study. Skeletal Radiol 2009;38(5):473-8.

[73] Prodanovic SZ, Radunovic G, Babic D, Ristic B, Sefik-Bukilica M, Zlatanovic M, et al. Matrix metalloproteinases-3 baseline serum levels in early rheumatoid arthritis patients without initial radiographic changes: a Two-Year Ultrasonographic Study. Med Princ Pract 2018;27(4):378-86.

[74] Alexeeva O, Smirnov A, Volkov A, Nasonov E. Is it possible to replace the radiological assessment of destructive changes in rheumatoid arthritis (RA) by ultrasound (US) examination? Clin Expe Rheumatol 2018;36:S70.

[75] Keeley GS, Evangelisto AM, Nishio MJ, Goss SL, Liu S, Kalabic J, et al. Methotrexate dosage reduction upon adalimumab initiation: clinical and ultrasonographic outcomes from the randomized noninferiority MUSICA Trial. J Rheumatol 2016;43(8):1480-9.

[76] Sreerangaiah D, Grayer M, Fisher BA, Ho M, Abraham S, Taylor PC. Quantitative power Doppler ultrasound measures of peripheral joint synovitis in poor prognosis early rheumatoid arthritis predict radiographic progression. Rheumatology (United Kingdom) 2016;55(1):89-93.

[77] Sarzi-Puttini P, Filippucci E, Adami S, Meroni PL, Batticciotto A, Idolazzi L, et al. Clinical, ultrasound, and predictability outcomes following certolizumab pegol treatment (with methotrexate) in patients with moderate-to-severe rheumatoid arthritis: 52-week results from the CZP-SPEED study. Adv Therapy 2018;35 (8):1153-68.

[78] Pereira DF, Natour J, Ribeiro LHC, Ferreira FBMD, Fernandes ARC, Furtado RNV. Painless and painful synovitis have similar ultrasound and clinical outcomes: one-year cohort study in longstanding rheumatoid arthritis women patients. Clin Exp Rheumatol 2020.

[79] Tan YK, Yihua L, Allen JC, Thumboo J. Ultrasound power doppler and grey-scale joint inflammation: what do they reveal about rheumatoid arthritis? Ann Rheum Dis 2019;78:2052-3.

[80] Sakellariou G, Iagnocco A, Filippucci E, Ceccarelli F, Di Geso L, Carli L, et al. Ultrasound imaging for the rheumatologist XLVIII. Ultrasound of the shoulders of patients with rheumatoid arthritis. Clin Exp Rheumatol 2013;31(6):837-42.

[81] Riente L, Sedie AD, Scirè CA, Filippucci E, Meenagh G, Iagnocco A, et al. Ultrasound imaging for the rheumatologist XXXI. Sonographic assessment of the foot in patients with rheumatoid arthritis. Clin Exp Rheumatol 2011;29(1):1-5.

[82] Genc H, Cakit BD, Tuncbilek I, Erdem HR. Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects. Clin Rheumatol 2005;24(3):272-7.

[83] Tinazzi I, McGonagle D, Zabotti A, Chessa D, Marchetta A, Macchioni P. Comprehensive evaluation of finger flexor tendon enthesese soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis. Clin Exp Rheumatol 2018;36(5):785-90.

[84] Frediani B, Falsetti P, Storri L, Allegri A, Bisogno S, Baldi F, et al. Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol 2002;21(3):203-6.

[85] Serban O, Papp I, Bocşa CD, Micu MC, Bădărînză M, Albu A, et al. Do ankle, hind-foot, and heel ultrasound findings predict the symptomatology and quality of life in rheumatoid arthritis patients? J Ultrasonogr 2020;20(81):e70-82.

[86] Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, et al. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 2014;66(5):741-8.

[87] Di Geso L, Filippucci E, Riente L, Sakellariou G, Sedie AD, Meenagh G, et al. Ultrasound imaging for the rheumatologist xl. Sonographic assessment of the hip in rheumatoid arthritis patients. Clin Exp Rheumatol 2012;30(4):464-8.

[88] Ciurtin C, Wyszynski K, Clarke R, Mouyis M, Manson J, Marra G. Ultrasound-detected subclinical inflammation was better reflected by the disease activity score (DAS-28) in patients with suspicion of inflammatory arthritis compared to established rheumatoid arthritis. Clin Rheumatol 2016;35(10):2411-9.

[89] Rodríguez-Henríquez P, Solano C, Pena A, Leon-Hernández S, Hernández-Díaz C, Gutiérrez M, et al. Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint. Arthritis Care Res 2013;65 (7):1177-82.

[90] El Binoue I, Amine B, Moudjibou W, Moussa F, Rkain H, Aktaou S, et al. Rheumatoid shoulder assessed by ultrasonography: prevalence of abnormalities and associated factors. Ann Rheum Dis 2015;74:883-4.

[91] Besselink NJ, van der Meijde P, Rensen WHJ, Meijer PBL, Marijnissen ACA, van Laar JM, et al. Optical spectral transmission to assess inflammation in hand and wrist joints of rheumatoid arthritis patients. Rheumatology (Oxford, England). 2018;57(5):865-72.

[92] Sivakumaran P, Hussain S, Attipoe L, Ciurtin C. Diagnostic accuracy of simplified ultrasound hand examination protocols for detection of inflammation and disease burden in patients with rheumatoid arthritis. Acta radiologica (Stockholm, Sweden: 1987) 2019;60(1):92-9.
sectional study of baseline data from the ESPOIR cohort. Rheumatology 2009;48 (12):1515-9.

[45] Ventura-Rios L, Hernandez-Diaz C, Sanchez-Brinas G, Madrigal-Santillan E. Morales-Gonzalez JA, Pineda C. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol 2016;35(9):2269-76.

[46] Acebes C, McKay N, Ciechomska A, Alcorn N, Harvie JP, Robson B, et al. Level of agreement between three-dimensional volumetric ultrasound and real-time conventional ultrasound in the assessment of synovitis, tenosynovitis and erosions in rheumatoid arthritis patients. Rheumatol Int 2017;37(2):197-205.

[47] Quintero M, Sánchez R, Arapé R, Sosa A, Escobar H, Rodríguez V, et al. Study of bone erosions of the metacarpophalangeal joints of patients with early rheumatoid arthritis by conventional radiology and ultrasound. J Clin Rheumatol 2018;24(3):S78-S9.

[48] Baan H, Drossaers-Bakker W, Dubbeldam R, Van De Laar M. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol 2011;30(11):1475-9.

[49] Vasanth LC, Foo LF, Potter HG, Adler RS, Finzel KC, Pavlov H, et al. Using magnetic resonance angiography to measure abnormal synovial blood vessels in early inflammatory arthritis: a new imaging biomarker? J Rheumatol 2010;37 (6):1129-35.

[50] Roux C, Gandjbakhk F, Pierreisdarn A, Couderc M, Lukas C, Masri R, et al. Optimization of ultrasonographic examination for the diagnosis of erosive rheumatoid Arthritis in comparison to erosive hand Osteoarthritis. Eur J Radiol 2019;118:10-8.

[51] Nakabo S, Tsuji Y, Inagaki M, Tsuji H, Nakajima T, Murakami K, et al. Severe joint deformity and patient global assessment of disease are associated with discrepancies between sonographic and clinical remission: a cross-sectional study of rheumatoid arthritis patients. Modern Rheumatol 2020:1-9.

[52] Ellegaard K, Bliddal H, Møller Døhn U, Henriksen M, Boesen M, Bouertin R, et al. Validity and reliability of 3D US for the detection of erosions in patients with rheumatoid arthritis using MRI as the gold standard. Ultraschall in der Medizin (Stuttgart, Germany) 1980;2014;35(2):137-41.

[53] Tamas MM, Filippucci E, Becciolini A, Gutierrez M, Di Geso L, Bonfiglioli K, et al. Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease. Rheumatology (Oxford) 2014;53(6):1100-7.

[54] Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005;32(12):2485-7.

[55] Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48(4):955-62.

[56] Kunkel GA, Cannon GW, Clegg DO. Combined structural and synovial assessment for Improved ultrasound Discrimination of rheumatoid, osteoarthritic, and normal joints: a pilot study. Open Rheumatol J 2012;6(1):199-206.

[57] Abaza N, Gadallah N, Elhosseiny M, El-Bakry SA, Yousry S. Verification of an ultrasonographic scoring system in discriminating rheumatoid from osteoarthritic and normal joints in an Egyptian cohort. Ann Rheum Dis 2015;74:1261.

[58] Lerch K, Herold T, Borisch N, Grifka J. Imaging in rheumatoid arthritis of the elbow. Die Bildgebung beim beim kranken Ellenbogen 2003;32(8):691-8.

[59] Amin MF, Ismail FM, El Shereef RR. The role of ultrasonography in early detection and monitoring of shoulder erosions, and disease activity in rheumatoid arthritis patients; comparison with MRI examination. Acad Radiol 2012;19 (6):693-700.

[60] Dohn UM, Ejberg B, Boonen A, Hetland ML, Hansen MS, Knudsen LS, et al. No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. Ann Rheum Dis 2011;70(2):252-8.

[61] Dohn UM, Terslev L, Szkudlarek M, Hansen MS, Hetland ML, Hansen A, et al. Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT. Ann Rheum Dis 2013;72(4):530-4.

[62] Saran S, Bagarhatta M, Saigal R. Diagnostic accuracy of ultrasonography in detection of destructive changes in small joints of hands in patients of rheumatoid arthritis: a comparison with magnetic resonance imaging. J Assoc Phys India 2016;64(11):26-30.

[63] Szkudlarek M, Klarlund M, Navarsted E, Court-Payen M, Strandberg C, Jensen KE, et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther 2006;8(2):R52.

[64] Hetta WM, Sharara SM, Gouda GA. Role of magnetic resonance imaging and ultrasonography in diagnosis and followup rheumatoid arthritis in hand and wrist joints. Egypt J Radiol Nucl Med 2018;49(4):1043-51.

[65] Falsetti P, Frediani B, Fioravanti A, Acciai C, Baldi F, Filippou G, et al. Sonographic study of calcaneal entheses in erosive osteoarthritis, nodal osteoarthritis, rheumatoid arthritis and psoriatic arthritis. Scand J Rheumatol 2003;32(4):229-34.

[66] Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48(4):955-62.

[67] Finzel S, Aegerter P, Schett G, D'Agostino MA. Identification, localization and differentiation of erosions and physiological bone channels by ultrasound in rheumatoid arthritis patients. Rheumatology (Oxford, England) 2020.

[68] Grosse J, Allado E, Albuisson É, Pierreisdarn A, Couderc M, Chary-Valckenaere I, et al. The USSe (UltraSound Score for Erosions) in the evaluation of bone erosions in RA compared to the SHSe (Van der Heijde-modified Sharp score for erosions). The J Rheumatol 2020.

[69] Serban O, Fodor D, Papp I, Micu MC, Duma DG, Csutak C, et al. Reasons for discor- dances between ultrasonography and magnetic resonance imaging in the evalu- ation of the ankle, hindfoot and heel of the patients with rheumatoid arthritis. Med Ultrasonogr 2019;21(4):405-13.

[70] Zou H, Beattie KA, Allen M, Ioannidis G, Larché MJ. Ultrasonography supplements clinical exam to improve early rheumatoid arthritis disease activity monitoring in metatarsophalangeal joints. Clin Rheumatol 2020;39(5):1483-91.

[71] Leng X, Xiao W, Xu Z, Zhu X, Liu Y, Zhao D, et al. Ultrasound7 versus ultrasound12 in monitoring the response to infliximab in patients with rheumatoid arthritis. Clin Rheumatol 2016;35(3):587-94.

[72] Reynolds PPM, Heron C, Pilcher J, Kiely PDW. Prediction of erosion progression using ultrasound in established rheumatoid arthritis: a 2-year follow-up study. Skeletal Radiol 2009;38(5):473-8.

[73] Prodanovic SZ, Radunovic G, Babic D, Ristic B, Sefik-Bukilica M, Zlatanovic M, et al. Matrix metalloproteinases-3 baseline serum levels in early rheumatoid arthritis patients without initial radiographic changes: a Two-Year Ultrasonographic Study. Med Princ Pract 2018;27(4):378-86.

[74] Alexeeva O, Smirnov A, Volkov A, Nasonov E. Is it possible to replace the radiological assessment of destructive changes in rheumatoid arthritis (RA) by ultrasound (US) examination? Clin Expe Rheumatol 2018;36:S70.

[75] Keeley GS, Evangelisto AM, Nishio MJ, Goss SL, Liu S, Kalabic J, et al. Methotrexate dosage reduction upon adalimumab initiation: clinical and ultrasonographic outcomes from the randomized noninferiority MUSICA Trial. J Rheumatol 2016;43(8):1480-9.

[76] Sreerangaiah D, Grayer M, Fisher BA, Ho M, Abraham S, Taylor PC. Quantitative power Doppler ultrasound measures of peripheral joint synovitis in poor prognosis early rheumatoid arthritis predict radiographic progression. Rheumatology (United Kingdom) 2016;55(1):89-93.

[77] Sarzi-Puttini P, Filippucci E, Adami S, Meroni PL, Batticciotto A, Idolazzi L, et al. Clinical, ultrasound, and predictability outcomes following certolizumab pegol treatment (with methotrexate) in patients with moderate-to-severe rheumatoid arthritis: 52-week results from the CZP-SPEED study. Adv Therapy 2018;35 (8):1153-68.

[78] Pereira DF, Natour J, Ribeiro LHC, Ferreira FBMD, Fernandes ARC, Furtado RNV. Painless and painful synovitis have similar ultrasound and clinical outcomes: one-year cohort study in longstanding rheumatoid arthritis women patients. Clin Exp Rheumatol 2020.

[79] Tan YK, Yihua L, Allen JC, Thumboo J. Ultrasound power doppler and grey-scale joint inflammation: what do they reveal about rheumatoid arthritis? Ann Rheum Dis 2019;78:2052-3.

[80] Sakellariou G, Iagnocco A, Filippucci E, Ceccarelli F, Di Geso L, Carli L, et al. Ultrasound imaging for the rheumatologist XLVIII. Ultrasound of the shoulders of patients with rheumatoid arthritis. Clin Exp Rheumatol 2013;31(6):837-42.

[81] Riente L, Sedie AD, Scirè CA, Filippucci E, Meenagh G, Iagnocco A, et al. Ultrasound imaging for the rheumatologist XXXI. Sonographic assessment of the foot in patients with rheumatoid arthritis. Clin Exp Rheumatol 2011;29(1):1-5.

[82] Genc H, Cakit BD, Tuncbilek I, Erdem HR. Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects. Clin Rheumatol 2005;24(3):272-7.

[83] Tinazzi I, McGonagle D, Zabotti A, Chessa D, Marchetta A, Macchioni P. Comprehensive evaluation of finger flexor tendon enthesese soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis. Clin Exp Rheumatol 2018;36(5):785-90.

[84] Frediani B, Falsetti P, Storri L, Allegri A, Bisogno S, Baldi F, et al. Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol 2002;21(3):203-6.

[85] Serban O, Papp I, Bocşa CD, Micu MC, Bădărînză M, Albu A, et al. Do ankle, hindfoot, and heel ultrasound findings predict the symptomatology and quality of life in rheumatoid arthritis patients? J Ultrasonogr 2020;20(81):e70-82.

[86] Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, et al. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 2014;66(5):741-8.

[87] Di Geso L, Filippucci E, Riente L, Sakellariou G, Sedie AD, Meenagh G, et al. Ultrasound imaging for the rheumatologist xl. Sonographic assessment of the hip in rheumatoid arthritis patients. Clin Exp Rheumatol 2012;30(4):464-8.

[88] Ciurtin C, Wyszynski K, Clarke R, Mouyis M, Manson J, Marra G. Ultrasound-detected subclinical inflammation was better reflected by the disease activity score (DAS-28) in patients with suspicion of inflammatory arthritis compared to established rheumatoid arthritis. Clin Rheumatol 2016;35(10):2411-9.

[89] Rodríguez-Henríquez P, Solano C, Pena A, Leon-Hernández S, Hernández-Díaz C, Gutiérrez M, et al. Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint. Arthritis Care Res 2013;65 (7):1177-82.

[90] El Binoue I, Amine B, Moudjibou W, Moussa F, Rkain H, Aktaou S, et al. Rheumatoid shoulder assessed by ultrasonography: prevalence of abnormalities and associated factors. Ann Rheum Dis 2015;74:883-4.

[91] Besselink NJ, van der Meijde P, Rensen WHJ, Meijer PBL, Marijnissen ACA, van Laar JM, et al. Optical spectral transmission to assess inflammation in hand and wrist joints of rheumatoid arthritis patients. Rheumatology (Oxford, England). 2018;57(5):865-72.

[92] Sivakumaran P, Hussain S, Attipoe L, Ciurtin C. Diagnostic accuracy of simplified ultrasound hand examination protocols for detection of inflammation and disease burden in patients with rheumatoid arthritis. Acta radiologica (Stockholm, Sweden: 1987) 2019;60(1):92-9.
[93] Darweesh H, Abbass D, Kadah R, Rashad A, El Basel M, Nasr AS. Serum and synovial cartilage oligomeric matrix protein (COMP) in patients with rheumatoid arthritis and osteoarthritis. Indian J Rheumatol 2010;5(3):112–7.

[94] Abdelrahman FI, Mortada MA, Abdul-Sattar A. Relation between restrictive pulmonary function tests and ultrasonographic changes of asymptomatic anterior chest wall joints in rheumatoid arthritispatients. Ann Rheum Dis 2019;78:2020–1.

[95] Mandl P, Studenic P, Supp G, Durechova M, Haider S, Lehner M, et al. Doubtful swelling on clinical examination reflects synovitis in rheumatoid arthritis. Therapeutic Adv Musculoskeletal Dis 2020;12.

[96] Ebadi A, Mortada MA, Atwa E, Hammad NM. Serum IL17 correlated with inflammatory changes but not with bony changes in both hand osteoarthritis and rheumatoid arthritis. Ann Rheum Dis 2019;78:1502.

[97] Disler DG, Raymond E, May DA, Wayne JS, McCauley TR. Articular cartilage defects: in vitro evaluation of accuracy and interobserver reliability for detection and grading with US. Radiology 2000;215(3):846–51.

[98] Pereira DF, Natour J, ALPd Buosi, Ferreira FBMD, AdRC Fernandes, Furtado RVN. Is painless synovitis different from painful synovitis? A controlled, ultrasound, radiographic, clinical trial. Clinics (Sao Paulo, Brazil), 2014;69(2):93–100.

[99] Hurnakova J, Filippucci E, Cipolletta E, Di Matteo A, Salaffi F, Carotti M, et al. Prevalence and distribution of cartilage damage at the metacarpal head level in rheumatoid arthritis and osteoarthritis: an ultrasound study. Rheumatology (United Kingdom) 2019;58(7):1206–13.

[100] Issar P, Nadiger VM, Hiran S, Issar SK. Ultrasound and magnetic resonance imaging: correlation of the wrist and metacarpophalangeal joints in fifty consecutive patients of rheumatoid arthritis. Indian J Rheumatol 2016;11(4):186–91.

[101] Luz KR, Pinheiro MM, Petterle GS, dos Santos MF, Fernandes ARC, Natour J, et al. A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients. Revista Brasileira de Reumatologia 2016;56(5):421–31.

[102] Cipolletta E, Filippucci E, Di Matteo A, Di Carlo M, Salaffi F, Grassi W. High-resolution ultrasound assessment of cartilage thinning in rheumatoid arthritis. Ann Rheum Dis 2019;78:2028–9.

[103] Ogura T, Hirata A, Hayashi N, Imaizumi C, Ito H, Takenaka S, et al. Finger joint cartilage evaluated by semi-quantitative ultrasound score in patients with rheumatoid arthritis. Arthritis Care Res 2019.

[104] Filippucci E, Da Luz KR, Di Geso L, Salaffi F, Tardella M, Carotti M, et al. Interobserver reliability of ultrasonography in the assessment of cartilage damage in rheumatoid arthritis. Ann Rheum Dis 2010;69(10):1845–8.

[105] Lund PJ, Heikal A, Maricic MJ, Krupinski EA, Williams CS. Sonographic imaging of the hand and wrist in rheumatoid arthritis. Skeletal Radiol 1995;24(8):591–6.

[106] Grassi W, Tittarelli E, Pirani O, Avaltroni D, Cervini C. Ultrasound examination of metacaropophalangeal joints in rheumatoid arthritis. Scandinavian J Rheumatol 1993;22(5):243–7.

[107] Iagnocco A, Coari G, Zoppini A. Sonographic evaluation of femoral condylar cartilage in osteoarthritis and rheumatoid arthritis. Scand J Rheumatol 1992;21(4):201–3.

[108] Mesci E, Mesci N, Madenci E. Ultrasonographic evaluation of femoral cartilage thickness in patients with rheumatoid arthritis. J Clin Anal Med 2016;7:31–4.

[109] Riente L, Delle Sedie A, Filippucci E, Scirè CA, Iagnocco A, Gutierrez M, et al. Ultrasound imaging for the rheumatologist XXVII. Sonographic assessment of the knee in patients with rheumatoid arthritis. Clin Exp Rheumatol 2010;28(3):300–3.

[110] Sakthiswary R, Rajalingam S, Hussein H, Sridharan R, Asrul AW. Cartilage oligomeric matrix protein (COMP) in rheumatoid arthritis and its correlation with sonographic knee cartilage thickness and disease activity. Clin Rheumatol 2017;36(12):2683–8.

[111] Bisi MC, do Prado AD, Rabelo C, Brollo F, da Silveira IG, de Mendonça JA, et al. Articular ultrasonography: interobserrvrer reliability in rheumatoid arthritis. Revista Brasileira de Reumatologia 2014;54(3):250–4.

[112] Pereira DF, Natour J, de Buosi ALP, Ferreira FBMD, Fernandes ARC, Furtado RVN. Is painless synovitis different from painful synovitis? A controlled, ultrasound, radiographic, clinical trial. Clinics 2014;69(2):93–100.

[113] Abda E, Hassanien MM, Abdelrazek E, Mahran SA. What can hand sonography and nerve conduction velocity disclose regarding hand dysfunction in rheumatoid arthritis patients? Zeitschrift fur Rheumatologie 2020.

[114] Yang J, Shao Q, Wu J, Lai JH. Correlation between high-frequency ultrasonography of patients with early rheumatoid arthritis and anti-CCP antibody. Medicine (United States) 2019;98(6).

[115] Riente L, Delle Sedie A, Filippucci E, Scire CA, Iagnocco A, Gutierrez M, et al. Ultrasound Imaging for the rheumatologist XXVII. Sonographic assessment of the knee in patients with rheumatoid arthritis. Clin Exp Rheumatol 2010;28(3):300–3.

[116] EL-M DN, El-Khouly RM, Mwafi MEED, Zyton HAEH. Magnetic resonance imaging versus musculoskeletal ultrasound in the evaluation of temporomandibular joint in rheumatoid arthritis patients. Egyptian Rheumatologist 2017;39(4):207–11.

[117] Filer A, De Pablo P, Allen G, Nightingale P, Jordan A, Johanputra P, et al. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann Rheum Dis 2011;70(3):500–7.

[118] Gutierrez M, Filippucci E, Ruta S, Salaffi F, Blasetti P, di Geso L, et al. Inter-observer reliability of high-resolution ultrasonography in the assessment of bone erosions in patients with rheumatoid arthritis: experience of an intensive dedicated training programme. Rheumatology 2011;50(2):373–80.

[119] Inanc N, Ozen G, Aydin SZ, Kasapoglu-Gunal E, Direskeneli H. Ultrasonographic assessment of fifth metatarsophalangeal joint erosion in rheumatoid arthritis: which aspect is better? Ultrasound Med 2016;42(4):864–9.

[120] Zayat AS, Ellegaard K, Conaghan PG, Terslev L, Hensor EMA, Freeston JE, et al. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis 2015;74(5):897–903.

[121] Bowen CJ, Dewbury K, Sampson M, Sawyer S, Burridge J, Edwards CJ, et al. Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist. J Foot Ankle Res 2008;1(1):5.

[122] Grosse J, Allado E, Roux C, Pierreisnard A, Couderc M, Clerc-Urmes I, et al. ACPA-positive versus ACPA-negative rheumatoid arthritis: two distinct erosive disease entities on radiography and ultrasonography. Rheumatol Int 2020;40(4):615–24.

[123] Bongi SM, Manetti R, Melchiorre D, Turchini S, Boccaccini P, Vanni L, et al. Anticyclic citrullinated peptide antibodies are highly associated with severe bone lesions in rheumatoid arthritis anti-CCP and bone damage in RA. Autoimmunity 2004;37(6-7):495–501.

[124] Botar-Jid C, Bolboaca S, Fodor D, Bocsa C, Tamas MM, Micu M, et al. Gray scale and power Doppler ultrasonography in evaluation of early rheumatoid arthritis. Med Ultrasonogr 2010;12(4):300–5.

[125] Buosi ALP, Natour J, Machado FS, Takahashi RD, Furtado RVN. Hand ultrasound: comparative study between "no rhopus" lupus erythematosus and rheumatoid arthritis. Modern Rheumatol 2014;24(4):599–605.

[126] Cai XH, Yang SP, Shen HL, Lin LQ, Zhong R, Wu RM, et al. Application of contrast-enhanced ultrasonography and ultrasonography scores in rheumatoid arthritis. Int J Clin Exp Med 2015;8(11):20056–64.

[127] Elkhouly T, Elnady BM, Ragh EMH. Validity of Doppler subclinical synovitis as an activity marker associated with bone erosions in rheumatoid arthritis patients during clinical remission. Egypt J Radiol Nucl Med 2016;47(3):985–90.

[128] Elsaman AM, Mostafa ES, Radwan AR. Ankle evaluation in active rheumatoid arthritis by ultrasound: a cross-sectional study. Ultrasound Med Biol 2017;43(12):2806–13.

[129] Funck-Brentano T, Gandjbakhch F, Etchepare F, Jousse-Joulin S, Miquel A, Cyteval C, et al. Prediction of radiographic damage in early arthritis by sonographic erosions and power doppler signal: a longitudinal observational study. Arthritis Care Res 2013;65(6):896–902.

[130] Hermann KGA, Backhaus M, Schneider U, Labs K, Loreck D, Zühlsdorf S, et al. Rheumatoid arthritis of the shoulder joint: comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging. Arthritis Rheum 2003;48(12):3338–49.

[131] Iagnocco A, Filippucci E, Perella C, Ceccarelli F, Cassarà E, Alessandri C, et al. Clinical and ultrasonographic monitoring of response to adalimumab treatment in rheumatoid arthritis. J Rheumatol 2008;35(1):35–40.

[132] Kawashiki SY, Suzuki T, Nakashima Y, Horai Y, Okada A, Iwamoto N, et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion. Rheumatology (United Kingdom) 2014;53(3):562–9.

[133] Machado FS, Furtado RVN, Takahashi RD, de Buosi ALP, Natour J. Sonographic cutoff values for detection of abnormalities in small, medium and large joints: a comparative study between patients with rheumatoid arthritis and healthy volunteers. Ultrasound Med Biol 2015;41(4):989–98.

[134] Naranjo A, Marrero-Pulido T, Ojeda S, Francisco F, Erausquin C, Rúa-Figueroa I, et al. Abnormal sonographic findings in the asymptomatic arthritic shoulder. Scandinavian J Rheumatol 2002;31(1):17–21.

[135] Vreju FA, Filippucci E, Gutierrez M, Di Geso L, Ciapetti A, Ciurea ME, et al. Subclinical ultrasound synovitis in a particular joint is associated with ultrasound evidence of bone erosions in that same joint in rheumatoid patients in clinical remission. Clin Exp Rheumatol 2016;34(4):673–8.

[136] Weidekamm C, Kölle M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 2003;48(2):325–33.

[137] Xu H, Zhang Y, Zhang H, Wang C, Mao P. Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis (RA). J Orthopaedic Surg Res 2017;12(1):152.

[138] Zou H, Beattie K, Ioannidis G, Larche M. Ultrasound finds discordance between disease activity in the hands and feet of patients with rheumatoid arthritis. J Rheumatol 2018;45(7):977.

[139] Serban T, Azzolin I, Satulu I, Mihai CM, Massazza G, Bojinca M, et al. Is ultrasound remission achievable in patients with early rheumatoid arthritis? Ann Rheum Dis 2018;77:1184.

[140] Okamoto M, Fujikawa K, Mizokami A, Endo Y, Mine M, Kawakami A. Diagnostic utility of metatarsophalangeal synovitis identified by ultrasonography for early rheumatoid arthritis. Ann Rheum Dis 2018;77:813.

[141] Hussein DA, El Bakry SA, Morshedy NA, Ibrahim SE, Sakr HM, Abo-Shady RA. Role of cartilage oligomeric matrix protein (COMP) as a prognostic biomarker in follow-up of early rheumatoid arthritis patients: correlation to musculoskeletal ultrasonographic findings. Egyptian Rheumatologist 2018;40(4):221–6.

[142] Erturk Z, Ozsoy T, Yagci I, Yalcinkaya Y, Gazel Ü, Atagündüz P, et al. Assessment of enthesitis by ultrasonography in patients with seronegative rheumatoid arthritis. Ann Rheum Dis 2018;77:1712.

[143] Sheane BJ, Beddy P, O'Connor M, Miller S, Cunnane G. Targeted ultrasound of the fifth metatarsophalangeal joint in an early inflammatory arthritis cohort. Arthritis Rheum 2009;61(7):1004–8.

[144] Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, et al. Ultrasonographic criteria for the diagnosis of erosive rheumatoid arthritis using
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[100] Issar P, Nadiger VM, Hiran S, Issar SK. Ultrasound and magnetic resonance imaging: correlation of the wrist and metacarpophalangeal joints in fifty consecutive patients of rheumatoid arthritis. Indian J Rheumatol 2016;11(4):186–91.

[101] Luz KR, Pinheiro MM, Petterle GS, dos Santos MF, Fernandes ARC, Natour J, et al. A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients. Revista Brasileira de Reumatologia 2016;56(5):421–31.

[102] Cipolletta E, Filippucci E, Di Matteo A, Di Carlo M, Salaffi F, Grassi W. High-resolution ultrasound assessment of cartilage thinning in rheumatoid arthritis. Ann Rheum Dis 2019;78:2028–9.

[103] Ogura T, Hirata A, Hayashi N, Imaizumi C, Ito H, Takenaka S, et al. Finger joint cartilage evaluated by semi-quantitative ultrasound score in patients with rheumatoid arthritis. Arthritis Care Res 2019.

[104] Filippucci E, Da Luz KR, Di Geso L, Salaffi F, Tardella M, Carotti M, et al. Interobserver reliability of ultrasonography in the assessment of cartilage damage in rheumatoid arthritis. Ann Rheum Dis 2010;69(10):1845–8.

[105] Lund PJ, Heikal A, Maricic MJ, Krupinski EA, Williams CS. Sonographic imaging of the hand and wrist in rheumatoid arthritis. Skeletal Radiol 1995;24(8):591–6.

[106] Grassi W, Tittarelli E, Pirani O, Avaltroni D, Cervini C. Ultrasound examination of metacaropophalangeal joints in rheumatoid arthritis. Scandinavian J Rheumatol 1993;22(5):243–7.

[107] Iagnocco A, Coari G, Zoppini A. Sonographic evaluation of femoral condylar cartilage in osteoarthritis and rheumatoid arthritis. Scand J Rheumatol 1992;21(4):201–3.

[108] Mesci E, Mesci N, Madenci E. Ultrasonographic evaluation of femoral cartilage thickness in patients with rheumatoid arthritis. J Clin Anal Med 2016;7:31–4.

[109] Riente L, Delle Sedie A, Filippucci E, Scirè CA, Iagnocco A, Gutierrez M, et al. Ultrasound imaging for the rheumatologist XXVII. Sonographic assessment of the knee in patients with rheumatoid arthritis. Clin Exp Rheumatol 2010;28(3):300–3.

[110] Sakthiswary R, Rajalingam S, Hussein H, Sridharan R, Asrul AW. Cartilage oligomeric matrix protein (COMP) in rheumatoid arthritis and its correlation with sonographic knee cartilage thickness and disease activity. Clin Rheumatol 2017;36(12):2683–8.

[111] Bisi MC, do Prado AD, Rabelo C, Brollo F, da Silveira IG, de Mendonça JA, et al. Articular ultrasonography: interobserrvrer reliability in rheumatoid arthritis. Revista Brasileira de Reumatologia 2014;54(3):250–4.

[112] Pereira DF, Natour J, de Buosi ALP, Ferreira FBMD, Fernandes ARC, Furtado RVN. Is painless synovitis different from painful synovitis? A controlled, ultrasound, radiographic, clinical trial. Clinics 2014;69(2):93–100.

[113] Abda E, Hassanien MM, Abdelrazek E, Mahran SA. What can hand sonography and nerve conduction velocity disclose regarding hand dysfunction in rheumatoid arthritis patients? Zeitschrift fur Rheumatologie 2020.

[114] Yang J, Shao Q, Wu J, Lai JH. Correlation between high-frequency ultrasonography of patients with early rheumatoid arthritis and anti-CCP antibody. Medicine (United States) 2019;98(6).

[115] Riente L, Delle Sedie A, Filippucci E, Scire CA, Iagnocco A, Gutierrez M, et al. Ultrasound Imaging for the rheumatologist XXVII. Sonographic assessment of the knee in patients with rheumatoid arthritis. Clin Exp Rheumatol 2010;28(3):300–3.

[116] EL-M DN, El-Khouly RM, Mwafi MEED, Zyton HAEH. Magnetic resonance imaging versus musculoskeletal ultrasound in the evaluation of temporomandibular joint in rheumatoid arthritis patients. Egyptian Rheumatologist 2017;39(4):207–11.

[117] Filer A, De Pablo P, Allen G, Nightingale P, Jordan A, Johanputra P, et al. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann Rheum Dis 2011;70(3):500–7.

[118] Gutierrez M, Filippucci E, Ruta S, Salaffi F, Blasetti P, di Geso L, et al. Inter-observer reliability of high-resolution ultrasonography in the assessment of bone erosions in patients with rheumatoid arthritis: experience of an intensive dedicated training programme. Rheumatology 2011;50(2):373–80.

[119] Inanc N, Ozen G, Aydin SZ, Kasapoglu-Gunal E, Direskeneli H. Ultrasonographic assessment of fifth metatarsophalangeal joint erosion in rheumatoid arthritis: which aspect is better? Ultrasound Med 2016;42(4):864–9.

[120] Zayat AS, Ellegaard K, Conaghan PG, Terslev L, Hensor EMA, Freeston JE, et al. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis 2015;74(5):897–903.

[121] Bowen CJ, Dewbury K, Sampson M, Sawyer S, Burridge J, Edwards CJ, et al. Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist. J Foot Ankle Res 2008;1(1):5.

[122] Grosse J, Allado E, Roux C, Pierreisnard A, Couderc M, Clerc-Urmes I, et al. ACPA-positive versus ACPA-negative rheumatoid arthritis: two distinct erosive disease entities on radiography and ultrasonography. Rheumatol Int 2020;40(4):615–24.

[123] Bongi SM, Manetti R, Melchiorre D, Turchini S, Boccaccini P, Vanni L, et al. Anticyclic citrullinated peptide antibodies are highly associated with severe bone lesions in rheumatoid arthritis anti-CCP and bone damage in RA. Autoimmunity 2004;37(6-7):495–501.

[124] Botar-Jid C, Bolboaca S, Fodor D, Bocsa C, Tamas MM, Micu M, et al. Gray scale and power Doppler ultrasonography in evaluation of early rheumatoid arthritis. Med Ultrasonogr 2010;12(4):300–5.

[125] Buosi ALP, Natour J, Machado FS, Takahashi RD, Furtado RVN. Hand ultrasound: comparative study between "no rhupus" lupus erythematosus and rheumatoid arthritis. Modern Rheumatol 2014;24(4):599–605.

[126] Cai XH, Yang SP, Shen HL, Lin LQ, Zhong R, Wu RM, et al. Application of contrast-enhanced ultrasonography and ultrasonography scores in rheumatoid arthritis. Int J Clin Exp Med 2015;8(11):20056–64.

[127] Elkhouly T, Elnady BM, Ragh EMH. Validity of Doppler subclinical synovitis as an activity marker associated with bone erosions in rheumatoid arthritis patients during clinical remission. Egypt J Radiol Nucl Med 2016;47(3):985–90.

[128] Elsaman AM, Mostafa ES, Radwan AR. Ankle evaluation in active rheumatoid arthritis by ultrasound: a cross-sectional study. Ultrasound Med Biol 2017;43(12):2806–13.

[129] Funck-Brentano T, Gandjbakhch F, Etchepare F, Jousse-Joulin S, Miquel A, Cyteval C, et al. Prediction of radiographic damage in early arthritis by sonographic erosions and power doppler signal: a longitudinal observational study. Arthritis Care Res 2013;65(6):896–902.

[130] Hermann KGA, Backhaus M, Schneider U, Labs K, Loreck D, Zühlsdorf S, et al. Rheumatoid arthritis of the shoulder joint: comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging. Arthritis Rheum 2003;48(12):3338–49.

[131] Iagnocco A, Filippucci E, Perella C, Ceccarelli F, Cassarà E, Alessandri C, et al. Clinical and ultrasonographic monitoring of response to adalimumab treatment in rheumatoid arthritis. J Rheumatol 2008;35(1):35–40.

[132] Kawashiki SY, Suzuki T, Nakashima Y, Horai Y, Okada A, Iwamoto N, et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion. Rheumatology (United Kingdom) 2014;53(3):562–9.

[133] Machado FS, Furtado RVN, Takahashi RD, de Buosi ALP, Natour J. Sonographic cutoff values for detection of abnormalities in small, medium and large joints: a comparative study between patients with rheumatoid arthritis and healthy volunteers. Ultrasound Med Biol 2015;41(4):989–98.

[134] Naranjo A, Marrero-Pulido T, Ojeda S, Francisco F, Erausquin C, Rúa-Figueroa I, et al. Abnormal sonographic findings in the asymptomatic arthritic shoulder. Scandinavian J Rheumatol 2002;31(1):17–21.

[135] Vreju FA, Filippucci E, Gutierrez M, Di Geso L, Ciapetti A, Ciurea ME, et al. Subclinical ultrasound synovitis in a particular joint is associated with ultrasound evidence of bone erosions in that same joint in rheumatoid patients in clinical remission. Clin Exp Rheumatol 2016;34(4):673–8.

[136] Weidekamm C, Kölle M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 2003;48(2):325–33.

[137] Xu H, Zhang Y, Zhang H, Wang C, Mao P. Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis (RA). J Orthopaedic Surg Res 2017;12(1):152.

[138] Zou H, Beattie K, Ioannidis G, Larche M. Ultrasound finds discordance between disease activity in the hands and feet of patients with rheumatoid arthritis. J Rheumatol 2018;45(7):977.

[139] Serban T, Azzolin I, Satulu I, Mihai CM, Massazza G, Bojinca M, et al. Is ultrasound remission achievable in patients with early rheumatoid arthritis? Ann Rheum Dis 2018;77:1184.

[140] Okamoto M, Fujikawa K, Mizokami A, Endo Y, Mine M, Kawakami A. Diagnostic utility of metatarsophalangeal synovitis identified by ultrasonography for early rheumatoid arthritis. Ann Rheum Dis 2018;77:813.

[141] Hussein DA, El Bakry SA, Morshedy NA, Ibrahim SE, Sakr HM, Abo-Shady RA. Role of cartilage oligomeric matrix protein (COMP) as a prognostic biomarker in follow-up of early rheumatoid arthritis patients: correlation to musculoskeletal ultrasonographic findings. Egyptian Rheumatologist 2018;40(4):221–6.

[142] Erturk Z, Ozsoy T, Yagci I, Yalcinkaya Y, Gazel Ü, Atagündüz P, et al. Assessment of enthesitis by ultrasonography in patients with seronegative rheumatoid arthritis. Ann Rheum Dis 2018;77:1712.

[143] Sheane BJ, Beddy P, O'Connor M, Miller S, Cunnane G. Targeted ultrasound of the fifth metatarsophalangeal joint in an early inflammatory arthritis cohort. Arthritis Rheum 2009;61(7):1004–8.

[144] Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, et al. Ultrasonographic criteria for the diagnosis of erosive rheumatoid arthritis using
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