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Evaluation of a new erosion score by musculoskeletal ultrasound in patients with rheumatoid arthritis

Is US ready for a new erosion score?

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Abstract

The objectives of this study are to evaluate a new semi-quantitative (0–5) musculoskeletal ultrasound (US) erosion score in patients with rheumatoid arthritis (RA) and to prove its usefulness in the detection of disease activity and success of therapy. Thirty-eight patients with RA (mean disease duration 10.1 ± 11.9 years) were enrolled. Start or change of therapy (DMARD/biologics) was an inclusion criterion. DAS28, laboratory (ESR and CRP) and US data were evaluated before new therapy initiation and after 1, 3, 6 and 12 months. Thirteen joints of the clinically more affected hand and forefoot (wrist and MCP, PIP, MTP joints 2–5) were analyzed for synovitis in grayscale (GS) and power Doppler (PD) US, tenosynovitis/paratenonitis in GS/PDUS (wrist, MCP level) and for erosions. Erosions were analyzed by a new semi-quantitative score (grade 0, no erosion; grade 1, <1 mm, grade 2, 1 to <2 mm; grade 3, 2 to ≤3 mm; grade 4, >3 mm; grade 5, multiple bone erosions). After 12 months, DAS28 decreased from 4.5 to 3.4 (p < 0.001), the synovitis score in GSUS from 26.3 to 12.8 (p = 0.001) and the synovitis score in PDUS from 10.6 to 4.1 (p < 0.001). The erosion score decreased from 21.5 to 18.1 (p = 0.046). There were longitudinal significant correlations between the new erosion score and both the DAS28 (r = 0.368; p = 0.025) and the synovitis score in PDUS (r = 0.365; p = 0.026) over a 1-year follow-up period. The new erosion score might be a useful tool for the evaluation of erosive changes by US in RA patients. In the course of DMARD and biologic therapy, it was responsive under 1-year follow-up examination.

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References

  1. Aletaha D, Neogi T, Silman AJ et al (2010) 2010 rheumatoid arthritis classification criteria. An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Ann Rheum Dis 69:1580–1588

    Article  PubMed  Google Scholar 

  2. Backhaus M, Kamradt T, Sandrock D et al (1999) Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 42(6):1232–1245

    Article  CAS  PubMed  Google Scholar 

  3. Walther M, Harms H, Krenn V et al (2001) Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum 44(2):331–338

    Article  CAS  PubMed  Google Scholar 

  4. Backhaus M, Ohrndorf S, Kellner H et al (2009) Evaluation of a novel 7-joint US score in daily rheumatologic practice: a pilot project. Arthritis Rheum 61(9):1194–1201

    Article  CAS  PubMed  Google Scholar 

  5. Backhaus TM, Ohrndorf S, Kellner H et al (2013) The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy. Ann Rheum Dis 72(7):1163–1169

    Article  PubMed Central  PubMed  Google Scholar 

  6. Naredo E, Gamero F, Bonilla G, Uson J, Carmona L, Laffon A (2005) Ultrasonographic assessment of inflammatory activity in rheumatoid arthritis: comparison of extended versus reduced joint evaluation. Clin Exp Rheumatol 23(6):881–884

    CAS  PubMed  Google Scholar 

  7. Hammer HB, Kvien TK (2011) Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis. Arthritis Res Ther 13(3):R78

    Article  PubMed Central  PubMed  Google Scholar 

  8. Wakefield RJ, Balint PV, Szkudlarek M et al (2005) Musculoskeletal US including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487

    PubMed  Google Scholar 

  9. Grassi W, Filippucci E, Farina A, Salaffi F, Cervini C (2001) Ultrasonography in the evaluation of bone erosions. Ann Rheum Dis 60:98–104

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Backhaus M, Burmester GR, Gerber T et al (2001) Guidelines for musculoskeletal US in rheumatology. Ann Rheum Dis 60:641–649

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Wakefield RJ, Gibbon WW, Conaghan PG et al (2000) The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 43(12):2762–2770

    Article  CAS  PubMed  Google Scholar 

  12. Backhaus M, Burmester GR, Sandrock D et al (2002) Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 61(10):895–904

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Scheel AK, Hermann KG, Ohrndorf S et al (2006) Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis 65(5):595–600

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Alasaarela E, Takalo R, Tervonen O, Hakala M, Suramo I (1997) Sonography and MRI in the evaluation of painful arthritic shoulder. Br J Rheumatol 36(9):996–1000

    Article  CAS  PubMed  Google Scholar 

  15. Ostendorf B, McQueen F, Scherer A, Schneider M (2008) Prognosis in early (rheumatoid) arthritis—the value of MRI and arthrosonography. Akt Rheumatol 33:337–341

    Article  Google Scholar 

  16. Sommier J, Michel-Batot C, Sauliere N et al (2006) Structural lesions in RA: proposition for a new semiquantitative score (ScUSSe: Scoring by UltraSound Structural erosion). Arthritis Rheum 54(Suppl 209) - [abstract]

  17. Szkudlarek M, Court-Payen M, Jacobsen S et al (2003) Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 48(4):955–962

    Article  PubMed  Google Scholar 

  18. Finzel S, Ohrndorf S, Englbrecht M et al (2011) A detailed comparative study of high-resolution US and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum 63:1231–1236

    Article  PubMed  Google Scholar 

  19. Scheel AK, Hermann KG, Kahler E et al (2005) A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthritis Rheum 52(3):733–743

    Article  PubMed  Google Scholar 

  20. Steinbrocker O, Traeger GH, Batterman RC (1949) Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc 140:659–662

    Article  CAS  PubMed  Google Scholar 

  21. Rau R, Wassenberg S, Herborn G et al (2001) Identification of radiologic healing phenomena in patients with rheumatoid arthritis. J Rheumatol 28(12):2608–2615

    CAS  PubMed  Google Scholar 

  22. Finzel S, Rech J, Schmidt S et al (2011) Repair of bone erosions in rheumatoid arthritis treated with tumor necrosis factor inhibitors is based on bone apposition at the base of the erosion. Ann Rheum Dis 70(9):1587–1593

    Article  CAS  PubMed  Google Scholar 

  23. Finzel S, Rech J, Schmidt S, Engelke K, Englbrecht M, Schett G (2013) Interleukin-6 receptor blockade induces limited repair of bone erosions in rheumatoid arthritis: a micro CT study. Ann Rheum Dis 72(3):396–400

    Article  CAS  PubMed  Google Scholar 

  24. Døhn UM, Skjødt H, Hetland ML et al (2007) No erosive progression revealed by MRI in rheumatoid arthritis patients treated with etanercept, even in patients with persistent MRI and clinical signs of joint inflammation. Clin Rheumatol 26:1857–1861

    Article  PubMed  Google Scholar 

  25. Døhn UM, Ejbjerg B, Boonen A et al (2011) 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 70(2):252–258

    Article  PubMed  Google Scholar 

  26. Døhn UM, Terslev L, Szkudlarek M et al (2013) Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT. Ann Rheum Dis 72(4):530–534

    Article  PubMed  Google Scholar 

  27. Schett G, Gravallese E (2012) Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment. Nat Rev Rheumatol 8(11):656–664

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Ohrndorf S, Fischer IU, Kellner H et al (2012) Reliability of the novel 7-joint ultrasound score (US7): results from an inter- and intra-observer study performed by rheumatologists. Arthritis Care Res (Hoboken) 64(8):1238–1243

    CAS  Google Scholar 

  29. Dougados M, Devauchelle-Pensec V, Ferlet JF et al (2013) The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound. Ann Rheum Dis 72(5):665–671

    Article  PubMed Central  PubMed  Google Scholar 

  30. Detert J, Bastian H, Listing J et al (2013) Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naive patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated study. Ann Rheum Dis 72(6):844–850

    Article  CAS  PubMed  Google Scholar 

  31. Ohrndorf S, Halbauer B, Martus P, Reiche B, Backhaus TM, Burmester GR, Backhaus M (2013) Detailed joint region analysis of the 7-joint ultrasound score: evaluation of an arthritis patient cohort over one year. Int J Rheumatol 2013:493848

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Funding

The study was funded by Chugai Pharma Marketing Frankfurt, Germany. Chugai did not exert any influence on the statistical analysis or preparation of the manuscript.

Disclosures

None.

Ethics approval

This study was conducted with the approval of the Ethical Committee Charite Berlin, Germany (EA1/179/09).

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Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    S. Ohrndorf, J. Messerschmidt, B. E. Reiche, G. R. Burmester & M. Backhaus

Authors
  1. S. Ohrndorf
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  2. J. Messerschmidt
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  3. B. E. Reiche
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  4. G. R. Burmester
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  5. M. Backhaus
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Corresponding author

Correspondence to M. Backhaus.

Additional information

S. Ohrndorf and J. Messerschmidt contributed equally to this work.

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Ohrndorf, S., Messerschmidt, J., Reiche, B.E. et al. Evaluation of a new erosion score by musculoskeletal ultrasound in patients with rheumatoid arthritis. Clin Rheumatol 33, 1255–1262 (2014). https://doi.org/10.1007/s10067-014-2646-7

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  • DOI: https://doi.org/10.1007/s10067-014-2646-7

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