Advances in sonographic scoring of rheumatoid arthritis.

Accurate assessment of disease activity and joint damage in rheumatoid arthritis (RA) is important for monitoring treatment efficiency and for prediction of the outcome of the disease. Therefore, a reliable imaging method needs to be used. Musculoskeletal ultrasound (US) is a sensitive method for the detection of both early inflammatory soft tissue lesions (eg, synovitis, tenosynovitis, and bursitis) and early bone lesions (eg, erosions) in arthritic joint diseases and correlates well with MRI. Several musculoskeletal US scores are used for monitoring RA disease activity. Different qualitative (0/1) and semiquantitative (0-3) systems and quantitative measurements are used. The semiquantitative four-grade system developed by Skudlarek et al, which evaluates joint effusion, synovial thickening, bone erosion and power Doppler activity, is used most often. The new seven-joint ultrasound (US7) score is the first US sum score system which combines soft tissue (synovitis and tenosynovitis/paratenonitis) and destructive lesions (erosions) in a composite scoring system. The US7 score provides a fast overview of disease activity in daily rheumatological practice. This article reviews different US scores and sum scoring systems and current and proposed activity in this field.