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Multicenter Study
. 2019 Jul 5;21(1):166.
doi: 10.1186/s13075-019-1930-y.

Assessing synovitis in the hands in patients with rheumatoid arthritis by ultrasound: an agreement study exploring the most inflammatory active side from two Norwegian trials

Lene Terslev  1   2 , Robin Christensen  3   4 , Anna-Birgitte Aga  5 , Joe Sexton  5 , Espen A Haavardsholm  5   6 , Hilde B Hammer  5
Affiliations
Multicenter Study

Assessing synovitis in the hands in patients with rheumatoid arthritis by ultrasound: an agreement study exploring the most inflammatory active side from two Norwegian trials

Lene Terslev et al. Arthritis Res Ther. .

Abstract

Objective: To assess if the right hand, the dominant hand, or the hand with more clinically swollen joints (SwJ) is per se the most inflamed and exhibits the greatest change during treatment and hence preferred for unilateral scoring of synovitis by ultrasound in rheumatoid arthritis (RA) patients.

Methods: Using data from two previously published Norwegian RA patient cohorts initiating treatment, bilateral metacarpophalangeal joint 1-5, proximal phalangeal joint 2+3, and wrists were evaluated by ultrasound. Using a 0-3 scoring system a grey-scale (GS), power Doppler (PD) and global synovitis score (GLOESS) was calculated for each hand (0-30). For precision, a difference of < ± 3 in sum score was pre-specified as indicating clinically insignificant difference in inflammatory activity for all three scores.

Results: Four hundred thirty-seven RA patients were included. Baseline ultrasound inflammation was statistically significantly higher in hands with more vs fewer SwJ ([mean difference, 95%CI] GS sum score 2.21[1.30 to 3.12], PD sum score 1.70 [0.94 to 2.47] and GLOESS 2.31[1.36 to 3.26]) and also exhibited significantly more change for all sum scores at 3 months follow-up (GS sum score 1.34 [0.60 to 2.08], PD sum score 1.17 [0.44 to 1.91], and GLOESS 1.43 [0.63 to 2.22]). No such differences were found between the dominant and the non-dominant or the right and the left hands at any time points.

Conclusion: The hand with clinically more SwJ is statistically more inflammatory active according to GS, Doppler, and GLOESS sum scores, exhibits a change during treatment, and is potentially the best choice for unilateral scoring systems.

Keywords: Dominant; Doppler; Hand; Inflammation; Rheumatoid arthritis; Synovitis; Ultrasound.

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Conflict of interest statement

Lene Terslev: speaker's fee from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen.

Anna-Birgitte Aga: Advisory boards for UCB, AbbVie and Pfizer, honoraria for development of educational material for UCB.

Espen Haarvardsholm: Research funding from Pfizer, UCB, Roche, MSD and AbbVie, honoraria as a speaker from Pfizer, UCB, Roche, and AbbVie, honoraria for development of educational material from Pfizer, and has been on advisory board for Pfizer.

Hilde Berner Hammer: Study grants from AbbVie/Pfizer and Roche. Speaker fees from AbbVie, Bristol-Myers Squibb, Roche, UCB Pharma, and Pfizer.

The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Bland-Altman plot of the distribution of the Doppler sum score, Global synovitis score (GLOESS) sum score, and grey-scale (GS) sum score for right and left hands. a Scatter plot: Doppler sum score ultrasound measured on the right and the left hand, with line of equality. b Bland-Altman plot: Difference against mean for Doppler sum score data. c Scatter plot: GLOESS sum score measured on the right and the left hands, with line of equality. d Bland-Altman plot: Difference against mean for GLOSS sum score data. e Scatter plot: GS sum score measured on the right and the left hands, with line of equality. f Bland-Altman plot: Difference against mean for GSUS sum score data
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References

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