Table 1

Ultrasonographic definitions of inflammatory and damage lesions and agreement between sonographers expressed by Kappa value

Ultrasonographic lesionDefinition
Grey scale (GS) synovitisGS synovitis was evaluated by including its two components (ie, joint effusion and synovial membrane hypertrophy), which was assessed according to the OMERACT definitions.26 In GS, the two components of synovitis (ie, joint effusion and synovial hypertrophy) was scored together according to a 4-point semi-quantitative assessment as follows: synovitis: grade 0=no synovitis; grade 1=minimal synovitis (below or at the level of bony joint line); grade 2=moderate synovitis (above level of bony joint line but without full distension of joint capsule); grade 3=severe synovitis (above level of bony joint line with distension of joint capsule which will appear convex).27 28
Power Doppler (PD) synovitisPD synovitis was scored by using a semi-quantitative 4-point scale, as follows: grade 0=no flow within the synovium; grade 1=up to three single spots signals or up to two confluent spots signals or one confluent spot+up to two single spots signals; grade 2=PD signals covering <50% of the area of the synovium; grade 3=PD signals in >50% of the area of the synovium.29
Joint erosionErosions were defined as intra-articular discontinuity of the bone surface that is visible in two perpendicular planes.26
Joint osteoproliferationThe OMERACT definition of osteophyte (osteoproliferation at the joint margins) was used.30
GS tenosynovitisGS tenosynovitis was defined on GS as abnormal anechoic and/or hypoechoic (relative to tendon fibres) tendon sheath widening, which can be related to both the presence of tenosynovial abnormal fluid and/or hypertrophy. On GS, tenosynovitis was graded according to a 4-point semi-quantitative scoring system as follows: grade 0=normal; grade 1=minimal; grade 2=moderate; grade 3=severe. Both longitudinal and transverse planes were performed in order to confirm the findings.31
PD tenosynovitisPD tenosynovitis was defined as the presence of peritendinous Doppler signal within the synovial sheath, seen in two perpendicular planes, excluding normal feeding vessels (ie, vessels at the mesotenon or vinculae or vessels entering the synovial sheath from surrounding tissues) only if the tendon shows peritendinous synovial sheath widening on B-mode. A 4-point semi-quantitative scoring system (ie, grade 0=no Doppler signal; grade 1=minimal; grade 2=moderate; grade 3=severe) can be used to score pathological peritendinous Doppler signal within the synovial sheath.31
EnthesitisEnthesitis was defined in accordance with the recently published OMERACT definitions and the registered elementary lesions will be: hypoechogenicity of the enthesis (hypoechoic tendon with loss of the normal fibrillar pattern); increased thickness of tendon at its insertion*; enthesophyte (a step up bony prominence at the end of the normal bone contour); calcifications; bone erosion at the enthesis; PD activity at enthesis <2 mm from the bone insertion.17
BursitisBursitis will be defined as an abnormal distension of the bursal wall, due to local effusion and/or synovial proliferation. PD signal was evaluated as present/absent.32
Peritendinits of the extensor tendon on metacarpophalangeal jointThe presence of peritenon extensor tendon inflammation was investigated by dorsal scans at the level of all fingers of both hands. This abnormality was defined as a hypoechoic swelling of the soft tissues surrounding the extensor digitorum tendons, with or without peritendinous PD signal.33 34
  • OMERACT, Outcome Measures in Rheumatology.