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Using US7S sum-scores for synovitis can prove to be
beneficial to identify the RA patients
with higher chance of clinically significant improvement.
The crucial therapeutic objective in rheumatoid arthritis
(RA) management is reinstating the normal physical functioning. Whether the
extent of synovial inflammation quantified by musculoskeletal ultrasound (US)
can predict current or future capacity for physical functioning is still
undisclosed. Hence, this study was performed to estimate the longitudinal relationship between physical
function assessed by the health assessment questionnaire (HAQ) and the German
7-joint ultrasound score (US7S) in a prospective cohort of RA patients.
For 30.9 ± 9.1 months, the patients suffering from RA
(n = 185 (46 with
incident and 139 with prevalent disease) were followed. The disease activity
score inculcated baseline and annual assessments in 28 joints (DAS28), HAQ and
US7S. The semiquantitative measurements of synovitis estimated by greyscale
(GS) and power Doppler (PD) in seven joints of the clinically dominant hand and
foot were a part of the US7S. These are then accumulated in PD and GS synovitis
sum-scores (PDsynSS and GssynSS). To estimate the longitudinal relationship
between GSsynSS, PDsynSS and HAQ, a linear mixed-effect model was used. The
standard and time-lag models were used to find the association between HAQ, and
GSsynSS, PDsynSS and DAS28 calculated at the same time or at the previous visit
12 months ago, respectively.
In univariate analysis HAQ score was positively related
with GSsynSS and PDsynSS with β coefficients significantly higher in incident
than in prevalent disease, when the standard model was used. Both synSSs were
individually no longe important predictors of HAQ score in multivariate
analysis. Both PDsynSS and GSsynSS were
significantly and negatively related with the current HAQ when the time-lag
model was used.
It was revealed that the US7 PD and GS synovitis sum-scores
alone were positively related with current functional status reflected by the
HAQ in RA patients, and this association was stronger in patients with early
disease. Over a period of one year, US7 PD and GS synovitis sum-scores were
predictive of the change in HAQ score when merged with the DAS28 or HAQ.
Arthritis Research & Therapy
The relationship between synovitis quantified by an ultrasound 7-joint inflammation score and physical disability in rheumatoid arthritis – a cohort study
Jakub Závada et al.
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