POS0680 GLOBAL ULTRASOUND SCORING SYSTEMS FOR ASSESSING SYNOVITIS IN RHEUMATOID ARTHRITIS: AN UPDATE BY THE OMERACT ULTRASOUND WORKING GROUP
Authors: P. Mandl, C. Watschinger, I. Gessl, L. Terslev, H. Keen, C. Pineda, B. Wildner, M. A. D ’agostino
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Musculoskeletal ultrasound (MSUS) is widely regarded as a valuable tool for assessing the full extent of synovitis in patients with rheumatoid arthritis (RA). In recent decades, numerous global ultrasound scores have been developed, however the number of joints, and choice of MSUS modality or elementary lesion (e.g. grey-scale [GS]and/or Doppler [D], synovial effusion [SE] and/or synovial hypertrophy [SH], etc.) to be included remained questionable. Following a systematic literature review (SLR) published in 2010 [1] which highlighted the heterogeneity of MSUS definitions, scoring systems and number of joints scanned to evaluate synovitis burden in RA, the OMERACT US Working Group (WG) developed a global synovitis scoring system (GLOESS) at joint and patient level (joint set), with standardized and validated definitions and grading of synovitis which advocates the use of a combined GS and D score, and synovial hypertrophy, but not synovial effusion as the elementary lesions denoting synovitis [2]. <h3>Objectives:</h3> To analyze the implementation and metric properties of the proposed GLOESS as scoring system to evaluate synovitis burden in RA. <h3>Methods:</h3> A SLR of Central, Embase and Medline databases was performed (31.3.2010 to 15.9.2023) by two independent reviewers updating our previous SLR [2]. Original research reports written in English which assessed the reliability, validity and sensitivity of global MSUS scoring systems in RA were included and data extracted using a predefined extraction sheet. <h3>Results:</h3> Of 1564 reports identified, 99 articles were included in the final review. The majority of global scoring systems were composed of semiquantitative grades of individual joints, quantitative grades were utilized in only 6/99 (6%) of studies, while a global score based on joints graded in binary fashion was investigated in 28/99 (28%) The joint set most commonly used was the 7-joint (wrist, metacarpophalangeal [MCP]2, MCP3, proximal interphalangeal [PIP]2, PIP3, metatarsophalangeal [MTP]2, MTP5 of the clinically more affected side) (15/99, 15%), and 12-joint (bilateral elbow, wrist, MCP2, MCP3, knee, ankle) (15/99, 15%), 22-joint (bilateral wrist, MCP1-5, PIP 1-5) (12/99, 12%) and 28-joint (bilateral shoulder, elbow, wrist, MCP 1-5, IP1, PIP 2-5, knee) sets (9/99, 9%), while more extensive sets were investigated more rarely. Regarding the consideration of SE or SH as signs of synovitis 40/99 (40%) considered only SH as proposed by the GLOESS, while 38/99 (38%) articles considered both – studies in the latter group were generally older as compared to the former. Regarding the use of a composite score (GS+D) this was evaluated in 22/99 (22%) studies, with the majority of studies evaluating the domains separately. All included studies assessed face and content validity, while 73/99 (73%) also assessed construct validity by comparison to clinical examination, laboratory findings or other imaging modalities. 34/99 (37%) evaluated responsiveness and 42/99 (42%) evaluated reliability. With regard to feasibility, time of evaluation varied from 15 to 60 min and tended to increase with the number of joints involved in the examination. <h3>Conclusion:</h3> MSUS can be regarded as a valuable tool for globally examining the extent of synovitis in RA. The adoption of GLOESS has a validated scoring system was clearly denoted in the more recently published articles, as well as the use of SH solely to define synovitis. Reduced joint counts are utilized more frequently than more extensive joint sets, especially for evaluating responsiveness. <h3>REFERENCES:</h3> [1] Mandl P et al. A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter. J Rheumatol. 2011;38(9):2055-62. [2] D'Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardised, consensus-based scoring system. RMD Open. 2017;3(1):e000428. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Peter Mandl Abbvie, Janssen, Abbvie, Janssen, Novartis, Clara Watschinger: None declared, Irina Gessl: None declared, Lene Terslev Janssen, Novartis and GE, Helen Keen: None declared, Carlos Pineda: None declared, Brigitte Wildner: None declared, Maria-Antonietta D'Agostino: None declared.