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Imaging
Original article
Development of a feasible and responsive ultrasound inflammation score for rheumatoid arthritis through a data-driven approach
  1. Anna-Birgitte Aga1,
  2. Hilde Berner Hammer1,
  3. Inge Christoffer Olsen1,
  4. Till Uhlig1,
  5. Tore K Kvien1,
  6. Désirée van der Heijde1,2,
  7. Hallvard Fremstad3,
  8. Tor Magne Madland4,
  9. Åse Stavland Lexberg5,
  10. Hilde Haukeland6,
  11. Erik Rødevand7,
  12. Christian Høili8,
  13. Hilde Stray9,
  14. Anne Lindtner Noraas10,
  15. Inger Johanne Widding Hansen11,
  16. Gunnstein Bakland12,13,
  17. Siri Lillegraven1,
  18. Elisabeth Lie1 and
  19. Espen A Haavardsholm1
  1. 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Rheumatology, Ålesund Hospital, Helse Møre og Romsdal HF, Ålesund, Norway
  4. 4Department of Rheumatology, Haukeland University Hospital, Helse Bergen HF, Bergen, Norway
  5. 5Department of Rheumatology, Drammen Hospital, Vestre Viken HF, Drammen, Norway
  6. 6Department of Rheumatology, Martina Hansens Hospital AS, Bærum, Norway
  7. 7Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  8. 8Department of Rheumatology, Hospital Østfold HF, Moss, Norway
  9. 9Haugesund Rheumatism HospitalAS, Haugesund, Norway
  10. 10The Rheumatology Clinic Dovland/Benvold, Kristiansand, Norway
  11. 11Department of Rheumatology, Sørlandet Hospital HF, Kristiansand, Norway
  12. 12Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway
  13. 13Institute of Clinical Medicine, University of Tromsø, Norway
  1. Correspondence to Dr Anna-Birgitte Aga; anna.birgitte.aga{at}gmail.com

Abstract

Objective To develop and validate a responsive and feasible ultrasound inflammation score for rheumatoid arthritis (RA).

Methods We used data from cohorts of early RA (development) and established RA starting/switching biologic therapy (validation). 4 tendons and 36 joints were examined by a grey scale (GSUS) and power Doppler semiquantitative ultrasound (PDUS) scoring system (full score). Ultrasound score components were selected based on factor analyses of 3-month change in the development cohort. Responsiveness was assessed by standardised response means (SRMs). We assessed the proportion of information retained from the full score by linear regression.

Results 118 patients with early and 212 patients with established RA were included. The final ultrasound score included 8 joints (metacarpophalangeal 1–2–3, proximal interphalangeal 2–3, radiocarpal, metatarsophalangeal 2–3) and 1 tendon (extensor carpi ulnaris) examined bilaterally. The 6-month SRMs for the final score were −1.24 (95% CI −1.47 to −1.02) for GSUS, and −1.09 (−1.25 to −0.92) for PDUS in early RA, with 87% of total information retained for GSUS and 90% for PDUS. The new score performed somewhat better than formerly proposed scores in the validation cohort.

Conclusions The Ultrasound in Rheumatoid Arthritis 9 joint/tendon score (USRA9) inflammation score showed good responsiveness, retained most of the information from the original full score and overall performed better than previous scores in a validation cohort.

Trial registration numbers NCT01205854, ACTRN12610000284066; Post-results.

  • Rheumatoid Arthritis
  • Ultrasonography
  • Inflammation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2016-000325

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    Footnotes

    • Contributors A-BA and EAH designed the study, recruited and enrolled participants, collected, analysed, and interpreted data, and wrote the report. ICO designed the study, analysed and interpreted data, and reviewed the manuscript. SL analysed, interpreted data and wrote the report. HBH designed the study, recruited participants, interpreted data and reviewed the manuscript. TU designed the study, recruited and enrolled participants, interpreted data, and reviewed the manuscript. HF, TMM, ÅSL, HH, ER, CH, HS, ALN, IJWH and GB recruited and enrolled patients, interpreted data, and reviewed the manuscript. DvdH and TKK designed the study, interpreted data and reviewed the manuscript. All authors have approved the final draft and vouch for the accuracy and completeness of the data and analyses.

    • Funding This trial was supported by the Norwegian Research Council, Norwegian South-Eastern Health Region, Norwegian Women's Public Health Association, Norwegian Rheumatism Association, investigator initiated research grants from AbbVie, UCB Pharma, Pfizer, MSD Norway, Roche Norway. Siemens Healthcare and GE Healthcare provided technical support regarding standardisation of ultrasound equipment. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

    • Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: EAH has received research funding from Pfizer, UCB, Roche, MSD and AbbVie for the submitted work, 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 that might have an interest on the submitted work in the previous 3 years. A-BA has been on advisory boards for UCB, AbbVie and Pfizer, and received honoraria for development of educational material for UCB. HBH has received honoraria as a speaker from AbbVie, Bristol-Myers Squibb, Roche, UCB Pharma and Pfizer. HH has been on advisory boards for UCB and AbbVie. GB has received honoraria as a speaker from AbbVie and has been on advisory board for Pfizer. DvdH has received consultancy honoraria from AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Celgene, Daiichi, Eli Lilly, Galapagos, Merck, Novartis, Pfizer, Roche, Sanofi Aventis, Janssen and UCB, and is owner of Imaging Rheumatology. TKK has received consultancy honoraria from AbbVie, Bristol-Myers Squibb, Celltrion, Epirus, Hospira, Merck-Serono, MSD, Orion Pharma, Pfizer and UCB that might have an interest on the submitted work in the previous 3 years.

    • Patient consent Obtained.

    • Ethics approval The study was approved by an Independent Ethics Committee (REC South-East; reference number 2010/744) and appropriate Institutional Review Boards.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.