Construct validity and reliability of ultrasound disease activity score in assessing joint inflammation in RA: comparison with DAS-28.

Abstract

OBJECTIVE:

To investigate the construct validity and reliability of US DAS compared with 28-joint DAS (DAS-28) in assessing joint inflammation and in prediction of structural damage in patients with RA.

METHODS:

Ninety patients with active RA were prospectively recruited and followed up during the 6 months of treatment. The patients underwent clinical, laboratory and X-ray assessment, along with blinded power Doppler US (PDUS) and grey-scale (GS) US (GSUS) examination at baseline and 6 months. A subgroup of 25/90 randomly assigned patients underwent MRI examination of their hands at baseline. A PDUS examination of 22 joints and GSUS examination for effusion/hypertrophy (E/H) of 28 joints were performed by two independent examiners, blinded to clinical findings. E/H was qualitatively assessed as absent or present, and PD signal was semi-quantitatively graded from 0 to 3. PDUS score for synovitis in 22 joints and GS score for E/H in 28 joints were included in US DAS calculation. Clinical scoring, PDUS and GSUS inter-observer reliability were evaluated.

RESULTS:

Strong correlation was found between US DAS and standard assessment of disease activity such as the DAS-28, ESR and CRP levels. Correlation between US DAS and patients' and physicians' visual analogue scale of activity was moderate, whereas correlations of US DAS with Health Assessment Questionnaire - Disability Index (HAQ-DI) and Short Form 36 Health Survey (SF-36) were weak to moderate. US DAS correlated with X-ray, MRI and US parameters and rates of joint damage.

CONCLUSION:

US DAS better anticipated future joint damage than standard DAS-28.

• Authors: Nemanja Damjanov, Goran Radunovic, Slavica Prodanovic, Vesna Vukovic, Vera Milic, Katarina Simic Pasalic, Dragoslav Jablanovic, Srdan Seric, Sanja Milutinovic, Nikola Gavrilov
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 51 Issue 1 Pg. 120-8 (Jan 2012) ISSN: 1462-0332 [Electronic] England
• PMID: 22072084 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Validation Study)

Topics

• Adult
• Aged
• Aged, 80 and over
• Arthritis, Rheumatoid (diagnosis, diagnostic imaging)
• Disease Progression
• Epidemiologic Methods
• Humans
• Magnetic Resonance Imaging (methods)
• Metacarpophalangeal Joint (pathology)
• Middle Aged
• Observer Variation
• Physical Examination (methods)
• Prognosis
• Severity of Illness Index
• Synovitis (diagnosis, diagnostic imaging)
• Ultrasonography, Doppler (methods)
• Wrist Joint (pathology)