SAT0488 Sensitivity to Change of a Combined Gray-Scale and Power Doppler Ultrasound Score for Synovitis in Comparison to a Sum Score of 5 Joints of the Wrist and Hand – One-Year Evaluation of an RA Cohort.
Authors: S. Ohrndorf, M.-A. D’Agostino, B. Schicke, R. J. Wakefield, L. Vogler, J. Messerschmidt, B. E. Reiche, G.-R. Burmester, E. Naredo, A. Iagnocco, M. Backhaus
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Several ultrasound (US) scoring systems have been proposed for evaluating objectively RA patients’ responsiveness under treatment [1-3]. <h3>Objectives</h3> To evaluate the sensitivity to change over one year of a combined gray-scale (GS) and power Doppler (PD) US score in RA patients taking different anti-rheumatic therapies in comparison to synovitis sum scores of 5 joints (US5). <h3>Methods</h3> USdata of 77 RA patients have been surveyed over the time of one year since inclusion of each patient. The clinically most affected hand (wrist and finger joints) was semi-quantitatively (0-3) assessed by GS and PDUS for synovitis (synovial fluid and/or synovial hypertrophy) [4]. In detail, radiocarpal, ulnocarpal and midcarpal wrist as well as the MCP2-5 and PIP2-5 joints were examined from dorsal and palmar at baseline, and 3, 6, 12 months after initiation/change of therapy (DMARD/Biologic). The combined score was the highest of either the GS or PDUS score with the same weight at joint level [5]. Each combined score was correlated to the 5-joint sum score of the wrist and hand (dorsal ulnocarpal, dorsal and palmar midcarpal regions, dorsal (only PDUS) and palmar MCP2,3 and PIP2,3 regions according to [2] without forefoot) at patient level each in GS and PDUS. Clinical examination by DAS28 was performed at the same time points than US. Correlations between the combined scores, the GS/PDUS5, and DAS28 were obtained by Spearman’s correlation coefficient. <h3>Results</h3> After baseline examination, 71.2% of included patients were on Biologic and 28.8% on DMARD therapy. The combined scores demonstrated longitudinal significant correlations with the DAS28 only in the dorsal midcarpal (r=0.29, p=0.015) and ulnocarpal (r=0.24, p=0.47) wrist regions, whereas the US5 sum score presented higher significant correlations both in GS (r=0.42, p&lt;0.01) and PDUS (r=0.54, p&lt;0.01). Including all time points, the highest correlations between the joint-level combined scores and the GSUS5 score were found for the following joint regions: midcarpal wrist from palmar (r=0.69) and from dorsal (r=0.63), ulnocarpal wrist (r=0.73), palmar MCP2 (r=0.76), palmar MCP3 (r=0.66; each p&lt;0.01). <h3>Conclusions</h3> Considering the whole patient group independently from therapy, the proposed combined score was only sensitive to change at the wrist joint level (dorsal midline and ulnocarpal) under different anti-rheumatic therapies. The US5 sum score was higher responsive independently from the US modality (GS/PDUS). <h3>References</h3> Naredo E, et al. Clin Exp Rheumatol 2005;23(6):881-4. Backhaus M, et al. Arthritis Rheum 2009;61(9):1194-1201. Perricone C, et al. Rheumatology (Oxford) 2012;51:866-73. Wakefield RJ, et al. J Rheumatol 2005;32:2485–7. Naredo E, et al. J Rheumatol. 2011 Sep;38(9):2063-7. <h3>Disclosure of Interest</h3> None Declared