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Does a Simplified 6-Joint Ultrasound Index Correlate Well Enough With the 28-Joint Disease Activity Score to Be Used in Clinical Practice?

Rosa, Javier MD; Ruta, Santiago MD; Saucedo, Carla MD; Navarta, David A. MD; Catoggio, Luis J. MD, PhD; García-Mónaco, Ricardo MD; Soriano, Enrique R. MD, MSC

JCR: Journal of Clinical Rheumatology: June 2016 - Volume 22 - Issue 4 - p 179–183
doi: 10.1097/RHU.0000000000000415
Original Articles

Objective Ultrasound (US) has become an important tool in the management of rheumatoid arthritis (RA) but it is time consuming in clinical practice. We compared 3 US indices (with different numbers of joints) with disease activity measured by the 28-Joint Disease Activity Score (DAS28) in order to find the most parsimonious index still useful in clinical practice.

Methods Sixty consecutive RA patients were included. The DAS28 score was calculated by the attending rheumatologist, and later in the day, they underwent US examination by another rheumatologist trained in US (bilateral gray-scale and power Doppler examination of the wrist and metacarpophalangeal and proximal interphalangeal joints). Three different US indices were constructed: index A (22 joints), index B (10 joints), and index C (6 joints).

Results All 3 US indices were significantly higher in patients with active disease versus inactive disease (P < 0.05 for all 3). Ultrasound index C showed the best correlation with DAS28 (rho = 0.5020, P < 0.0001) and a very good discriminative value for moderate to high disease activity (DAS28 >3.2) and for absence of remission (DAS28 >2.6) (areas under receiver operating characteristic curve = 0.75 and 0.80, respectively). A cutoff value of 3 in US index C showed sensitivity of 88.89% and specificity of 66.67% for absence of remission. Correlation between the 3 US indices was excellent.

Conclusions A US index of 6 joints (both wrists and second and third metacarpophalangeal joints bilaterally) correlated well with disease activity measured by DAS28 and may be used to evaluate RA patients in daily practice.

From the *Sección Reumatología, Servicio de Clínica Médica and Instituto Universitario Escuela de Medicina, Hospital Italiano de Buenos Aires; †Fundación Dr Pedro M. Catoggio para el Progreso de la Reumatología; and ‡Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

The authors declare no conflict of interest.

Correspondence: Javier Rosa, MD, Juan D. Perón 4190 (C1181ACH) Buenos Aires, Argentina Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Argentina. E-mail:

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