HuiHua Li1, John Carson Allen2, Julian Thumboo3,4,5, York Kiat Tan6,7,8. 1. Health Services Research, Singapore General Hospital, Singapore, Singapore. 2. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore. 3. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. 4. Duke-NUS Medical School, Singapore, Singapore. 5. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 6. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. tan.york.kiat@singhealth.com.sg. 7. Duke-NUS Medical School, Singapore, Singapore. tan.york.kiat@singhealth.com.sg. 8. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. tan.york.kiat@singhealth.com.sg.
Abstract
OBJECTIVE: To investigate whether ultrasound greyscale (GS) and power Doppler (PD) joint inflammation may be useful in identifying rheumatoid arthritis (RA) patients in different states of structural damage and disease activity. METHODS: In this cross-sectional study utilizing 36-joint ultrasonography, bone erosion was scored dichotomously (1 = yes/0 = no) while GS and PD joint inflammations were graded semi-quantitatively (0-3) at each joint recess. Sensitivity, specificity and receiver operating characteristic (ROC) curve analysis was applied to study ultrasound joint inflammation as a clinical marker for identifying patients with erosion score > 4.5 (median) and DAS28 > 2.6, > 3.2 and > 5.1, respectively. RESULTS: 1080 joints and 1800 joint recesses were scanned in 30 RA patients (mean disease duration, 70.3 months). Patients with GS score > 35.5 (median) had significantly higher ultrasound erosion scores when compared to those with GS score ≤ 35.5 (mean (95% CI) ultrasound erosion scores, 9.27 (6.12-12.4) versus 3.33 (2.31-4.36), respectively. p = 0.0027). Patients with PD positivity had significantly higher DAS28 scores compared to those with PD negativity (mean (95% CI) DAS28, 3.84 (3.35, 4.34) versus 2.86 (2.18, 3.54), respectively. p = 0.0457). Area under the ROC curve (AUC) based on cut-off GS scores ≥ 38 to identify patients with ultrasound erosion score >4.5 was 0.82 (sensitivity = 73.3%, specificity = 86.7%, accuracy = 80%). AUC based on cut-off PD scores ≥ 2.5 for identifying patients with DAS28 > 5.1 was 0.88 (sensitivity = 100%, specificity = 69.2%, accuracy = 73.3%). CONCLUSIONS: Ultrasound GS and PD joint inflammation scores can be useful in identifying RA patients with high bone erosion burden (ultrasound erosion score > 4.5) and high disease activity (DAS28 > 5.1), respectively.
OBJECTIVE: To investigate whether ultrasound greyscale (GS) and power Doppler (PD) joint inflammation may be useful in identifying rheumatoid arthritis (RA) patients in different states of structural damage and disease activity. METHODS: In this cross-sectional study utilizing 36-joint ultrasonography, bone erosion was scored dichotomously (1 = yes/0 = no) while GS and PD joint inflammations were graded semi-quantitatively (0-3) at each joint recess. Sensitivity, specificity and receiver operating characteristic (ROC) curve analysis was applied to study ultrasound joint inflammation as a clinical marker for identifying patients with erosion score > 4.5 (median) and DAS28 > 2.6, > 3.2 and > 5.1, respectively. RESULTS: 1080 joints and 1800 joint recesses were scanned in 30 RApatients (mean disease duration, 70.3 months). Patients with GS score > 35.5 (median) had significantly higher ultrasound erosion scores when compared to those with GS score ≤ 35.5 (mean (95% CI) ultrasound erosion scores, 9.27 (6.12-12.4) versus 3.33 (2.31-4.36), respectively. p = 0.0027). Patients with PD positivity had significantly higher DAS28 scores compared to those with PD negativity (mean (95% CI) DAS28, 3.84 (3.35, 4.34) versus 2.86 (2.18, 3.54), respectively. p = 0.0457). Area under the ROC curve (AUC) based on cut-off GS scores ≥ 38 to identify patients with ultrasound erosion score >4.5 was 0.82 (sensitivity = 73.3%, specificity = 86.7%, accuracy = 80%). AUC based on cut-off PD scores ≥ 2.5 for identifying patients with DAS28 > 5.1 was 0.88 (sensitivity = 100%, specificity = 69.2%, accuracy = 73.3%). CONCLUSIONS: Ultrasound GS and PD joint inflammation scores can be useful in identifying RApatients with high bone erosion burden (ultrasound erosion score > 4.5) and high disease activity (DAS28 > 5.1), respectively.
Entities:
Keywords:
Bone erosion; Joints; Rheumatoid arthritis; Synovitis; Ultrasound
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