Lene Terslev1,2, Annamaria Iagnocco3,4, George A W Bruyn3,4, Esperanza Naredo3,4, Jelena Vojinovic3,4, Paz Collado3,4, Nemanja Damjanov3,4, Andrew Filer3,4, Georgios Filippou3,4, Stephanie Finzel3,4, Frederique Gandjbakhch3,4, Kei Ikeda3,4, Helen I Keen3,4, Marion C Kortekaas3,4, Silvia Magni-Manzoni3,4, Sarah Ohrndorf3,4, Carlos Pineda3,4, Viviana Ravagnani3,4, Bethan Richards3,4, Ilfita Sahbudin3,4, Wolfgang A Schmidt3,4, Heidi J Siddle3,4, Maria S Stoenoiu3,4, Marcin Szkudlarek3,4, Nikolay Tzaribachev3,4, Maria-Antonietta D'Agostino3,4. 1. From the Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; Department of Rheumatology, Zealand's University Hospital, Køge, Denmark; Dipartimento Scienze Cliniche e Biologiche - Reumatologia, Università degli Studi di Torino, Turin; Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena; Pediatric Rheumatology Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Rome; Internal Medicine Department, Azienda Socio Sanitaria Territoriale di Mantova, C. Poma Hospital, Mantua, Italy; Department of Rheumatology, MC Groep, Lelystad; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; Autónoma University; Hospital Universitario Severo Ochoa, Madrid, Spain; Clinic Center, Faculty of Medicine, University of Niš, Niš; Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Rheumatology Research Group, The University of Birmingham, Birmingham; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg; Charite University Hospital, Humboldt University; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; APHP, Department of Rheumatology, CHU Pitie-Salpetriere, Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health; APHP, Hôpital Ambroise Paré, Rheumatology Department, 92100 Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, 78180 Saint-Quentin en Yvelines, Paris, France; Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan; Department of Rheumatology, Royal Perth Hospital, Perth, Australia; Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Rheumatology Institute of Rheumatology and Orthopedics, Royal Prince Alfred Hospital, Camperdown, Australia; Department of Rheumatology, Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium. terslev@dadlnet.dk. 2. L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; A. Iagnocco, MD, Dipartimento Scienze Cliniche e Biologiche - Reumatologia, Università degli Studi di Torino; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, and Autónoma University; J. Vojinovic, MD, PhD, Clinic Center, Faculty of Medicine, University of Niš; P. Collado, MD, Hospital Universitario Severo Ochoa; N. Damjanov, MD, PhD, Institute of Rheumatology, Faculty of Medicine, University of Belgrade; A. Filer, MD, PhD, Rheumatology Research Group, The University of Birmingham; G. Filippou, MD, Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg; F. Gandjbakhch, MD, APHP, Department of Rheumatology, CHU Pitie-Salpetriere, Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health; K. Ikeda, MD, PhD, Department of Allergy and Clinical Immunology, Chiba University Hospital; H.I. Keen, MD, PhD, Department of Rheumatology, Royal Perth Hospital; M.C. Kortekaas, MD, PhD, Department of Rheumatology, Leiden University Medical Center; S. Magni-Manzoni, MD, Pediatric Rheumatology Unit, IRCCS Ospedale Pediatrico Bambino Gesù; S. Ohrndorf, MD, Charite University Hospital, Humboldt University; C. Pineda, MD, Research Directorate, Instituto Nacional de Rehabilitacion; V. Ravagnani MD, PhD, Internal Medicine Department, Azienda Socio Sanitaria Territoriale di Mantova, C. Poma Hospital; B. Richards, MD, Rheumatology Institute of Rheumatology and Orthopedics, Royal Prince Alfred Hospital; I. Sahbudin, MD, Rheumatology Research Group, The University of Birmingham; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; H.J. Siddle, MSc, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; M. Szkudlarek, MD, PhD, Department of Rheumatology, Zealand's University Hospital at Køge; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, 92100 Boulogne-Billancourt, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University. terslev@dadlnet.dk. 3. From the Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; Department of Rheumatology, Zealand's University Hospital, Køge, Denmark; Dipartimento Scienze Cliniche e Biologiche - Reumatologia, Università degli Studi di Torino, Turin; Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena; Pediatric Rheumatology Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Rome; Internal Medicine Department, Azienda Socio Sanitaria Territoriale di Mantova, C. Poma Hospital, Mantua, Italy; Department of Rheumatology, MC Groep, Lelystad; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; Autónoma University; Hospital Universitario Severo Ochoa, Madrid, Spain; Clinic Center, Faculty of Medicine, University of Niš, Niš; Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Rheumatology Research Group, The University of Birmingham, Birmingham; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg; Charite University Hospital, Humboldt University; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; APHP, Department of Rheumatology, CHU Pitie-Salpetriere, Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health; APHP, Hôpital Ambroise Paré, Rheumatology Department, 92100 Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, 78180 Saint-Quentin en Yvelines, Paris, France; Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan; Department of Rheumatology, Royal Perth Hospital, Perth, Australia; Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Rheumatology Institute of Rheumatology and Orthopedics, Royal Prince Alfred Hospital, Camperdown, Australia; Department of Rheumatology, Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium. 4. L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; A. Iagnocco, MD, Dipartimento Scienze Cliniche e Biologiche - Reumatologia, Università degli Studi di Torino; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep; E. Naredo, MD, Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, and Autónoma University; J. Vojinovic, MD, PhD, Clinic Center, Faculty of Medicine, University of Niš; P. Collado, MD, Hospital Universitario Severo Ochoa; N. Damjanov, MD, PhD, Institute of Rheumatology, Faculty of Medicine, University of Belgrade; A. Filer, MD, PhD, Rheumatology Research Group, The University of Birmingham; G. Filippou, MD, Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg; F. Gandjbakhch, MD, APHP, Department of Rheumatology, CHU Pitie-Salpetriere, Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health; K. Ikeda, MD, PhD, Department of Allergy and Clinical Immunology, Chiba University Hospital; H.I. Keen, MD, PhD, Department of Rheumatology, Royal Perth Hospital; M.C. Kortekaas, MD, PhD, Department of Rheumatology, Leiden University Medical Center; S. Magni-Manzoni, MD, Pediatric Rheumatology Unit, IRCCS Ospedale Pediatrico Bambino Gesù; S. Ohrndorf, MD, Charite University Hospital, Humboldt University; C. Pineda, MD, Research Directorate, Instituto Nacional de Rehabilitacion; V. Ravagnani MD, PhD, Internal Medicine Department, Azienda Socio Sanitaria Territoriale di Mantova, C. Poma Hospital; B. Richards, MD, Rheumatology Institute of Rheumatology and Orthopedics, Royal Prince Alfred Hospital; I. Sahbudin, MD, Rheumatology Research Group, The University of Birmingham; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; H.J. Siddle, MSc, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; M. Szkudlarek, MD, PhD, Department of Rheumatology, Zealand's University Hospital at Køge; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; M.A. D'Agostino, MD, PhD, APHP, Hôpital Ambroise Paré, Rheumatology Department, 92100 Boulogne-Billancourt, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University.
Abstract
OBJECTIVE: To provide an update from the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group on the progress for defining ultrasound (US) minimal disease activity threshold at joint level in rheumatoid arthritis (RA) and for standardization of US application in juvenile idiopathic arthritis (JIA). METHODS: For minimal disease activity, healthy controls (HC) and patients with early arthritis (EA) who were naive to disease-modifying antirheumatic drugs were recruited from 2 centers. US was performed of the hands and feet, and scored semiquantitatively (0-3) for synovial hypertrophy (SH) and power Doppler (PD). Synovial effusion (SE) was scored a binary variable. For JIA, a Delphi approach and subsequent validation in static images and patient-based exercises were used to developed preliminary definitions for synovitis and a scoring system. RESULTS: For minimal disease activity, 7% HC had at least 1 joint abnormality versus 30% in the EA group. In HC, the findings of SH and PD were predominantly grade 1 whereas all grades were seen in the EA cohort, but SE was rare. In JIA, synovitis can be diagnosed based on B-mode findings alone because of the presence of physiological vascularization. A semiquantitative scoring system (0-3) for synovitis for both B-mode and Doppler were developed in which the cutoff between Doppler grade 2 and grade 3 was 30%. CONCLUSION: The first step has been taken to define the threshold for minimal disease activity in RA by US and to define and develop a scoring system for synovitis in JIA. Further steps are planned for the continuous validation of US in these areas.
OBJECTIVE: To provide an update from the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group on the progress for defining ultrasound (US) minimal disease activity threshold at joint level in rheumatoid arthritis (RA) and for standardization of US application in juvenile idiopathic arthritis (JIA). METHODS: For minimal disease activity, healthy controls (HC) and patients with early arthritis (EA) who were naive to disease-modifying antirheumatic drugs were recruited from 2 centers. US was performed of the hands and feet, and scored semiquantitatively (0-3) for synovial hypertrophy (SH) and power Doppler (PD). Synovial effusion (SE) was scored a binary variable. For JIA, a Delphi approach and subsequent validation in static images and patient-based exercises were used to developed preliminary definitions for synovitis and a scoring system. RESULTS: For minimal disease activity, 7% HC had at least 1 joint abnormality versus 30% in the EA group. In HC, the findings of SH and PD were predominantly grade 1 whereas all grades were seen in the EA cohort, but SE was rare. In JIA, synovitis can be diagnosed based on B-mode findings alone because of the presence of physiological vascularization. A semiquantitative scoring system (0-3) for synovitis for both B-mode and Doppler were developed in which the cutoff between Doppler grade 2 and grade 3 was 30%. CONCLUSION: The first step has been taken to define the threshold for minimal disease activity in RA by US and to define and develop a scoring system for synovitis in JIA. Further steps are planned for the continuous validation of US in these areas.
Authors: Alexander Lautwein; Benedikt Ostendorf; Stefan Vordenbäumen; Aiko Liedmann; Ralph Brinks; Mario Giulini; Sarah Ohrndorf; Marina Backhaus; Hasan Acar; Oliver Sander; Jutta G Richter; Matthias Schneider; Philipp Sewerin Journal: Adv Rheumatol Date: 2022-01-04