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Abstract

 BACKGROUND:In patients with rheumatoid arthritis (RA) a poor relation on an individual joint basis, has beenobserved between clinical signs of synovitis and ultrasound measures of synovial disease.OBJECTIVE:To compare the traditional clinical measures of disease activity with the ultrasound (US)features of synovitis, and investigate the relationship between composite US measures anddisease activity score in 28 joints (DAS28), clinical disease activity index (CDAI), theircomponents and other variables of disease activity in RA.METHODS:Fifty patients with RA were enrolled in this study. The following 28 joints including bilateralglenohumeral, elbow, wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) of thehands, and knee joints were assessed for tenderness and swelling. DAS28 and CDAI weredetermined for each patient. A systematic US examination was carried out by a radiologist forthe 28 clinically examined joints. Each joint was evaluated for the presence of synovialhypertrophy (SH), power Doppler (PD) signals, and effusion. The following composite USmeasures of synovial disease were made: SH joint count (SHJC), effusion joint count (EJC), PDjoint count (PDJC), SH index (SHI), and PD index (PDI).RESULTS:Joints with tenderness only showed significantly less PD scores than other groups. SH and PDsignals were detected in 32.1% and 27.8% of the Nil group respectively. SHJC and SHI showedmoderate correlation with TJC and high correlation with SJC, evaluator global assessment(EGA), patient global assessment (PGA), DAS28, CDAI, and erythrocyte sedimentation rate(ESR). PDJC and PDI showed moderate correlations with tender joint count (TJC), and highcorrelation with swollen joint count (SJC), EGA, DAS28, and ESR. PDI showed high correlationwith PGA, and CDAI.CONCLUSION:Traditional clinical signs used in the evaluation for disease activity may bear different relation tothe US features of synovitis (SH, PD signals). Composite US count and indices for SH and PDrelate significantly to the DAS28-ESR, CDAI, and their components.

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