Background
Methods
Systematic literature search
Selection of studies based on inclusion and exclusion criteria
Data extraction
Quality assessment and analyses
Study | Study population | N | Female (%) | Age (years; mean (±SD) or median (IQR)) | Symptom duration at inclusion (mean (±SD) or median (IQR)) | Outcome of relevance | Mean follow-up duration (months; mean (±SD) or median (IQR)) | N (%) patients with outcome | Duration until diagnosis/ outcome (months) | Univariable | Adjustment factors | Multivariable |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Rakieh et al. 2015 [11] |
ACPA+ patients with MSK symptoms
(primary and secondary care)
|
100
|
69
|
51.2 ± 11.9
|
22.7 (8.2–42.4) months
|
IA
|
19.8 (7.6–34.4)
|
50 (50.0)
|
7.9 (3.2–14.5)
|
PDUS≥ 1: HR 1.88 (1.07–3.29)
|
Tenderness small joints
Morning stiffness ≥ 30 min
High ++ RF and/or ACPA
|
PDUS ≥ 1: HR 1.51 (0.83–2.74)
¥
|
Nam et al. 2016 [10] |
ACPA+ patients with MSK symptoms
(primary and secondary care)
|
136
|
73.7
|
51.3 ± 12.4
|
17.2 (7.0–33.4) months
|
IA
|
28.1 (range 4.7–79.6) for non-progressors
|
57 (41.9)
|
18.3 (range 0.1–79.6)
|
GSUS ≥ 2: HR 2.8 (0.4–20.3)
PDUS ≥ 1: HR 1.6 (0.9–3.2)
|
None
|
ND
|
van der Ven et al. 2017 [8] |
Inflammatory arthralgia in > = 2 painful joints (hands, feet, shoulders), plus 2 additional criteria*
(secondary care)
|
174
|
83
|
45.0 ± 11.3
|
7.0 ± 3.1 months
|
IA
|
12
|
31 (17.8)
|
Within 1 year; not specified
|
GSUS ≥ 2 and/or PDUS ≥ 1
⌃
:
OR 3.03 (1.69–5.41)
PDUS ≥ 1:
OR 3.12 (1.61–6.03)
|
GSUS ≥ 2 and/or PDUS ≥ 1
⌃
:
Age
Morning stiffness > 30 min
ACPA
PDUS ≥ 1:
Age
Morning stiffness > 30 min
|
GSUS ≥ 2 and/or PDUS ≥ 1
⌃
:
OR 2.65 (1.44–4.88)
PDUS ≥ 1:
OR 3.44 (1.71–6.95)
|
van de Stadt et al. 2010 [12] | Arthralgia with RF+ and/or ACPA+ (secondary care) | 192 | 72 | 47 ± 11 | 12 (9–36) months | Arthritis | 26 (range 6–54) | 45 (23.4) | 11 ± 9 | Synovitis: OR 1.41 (0.54–3.65) PDUS: OR 1.54 (0.67–3.54) Effusion: OR 2.05 (0.80–5.27) Tenosynovitis: OR 1.50 (0.44–5.11) | None | ND |
Pratt et al. 2013 [9] | Inflammatory arthralgia (secondary care) | 379 | 72 | 51 (36–66) | 20 (10–34) weeks | Persistent IAǂ | 27 (range 12–44) | 162 (42.7) | NP | NP | Age Symptom duration Swollen joint count CRP ACPA ESR | Grade 1 GSUS synovitis in ≥ 3/16 joints: OR 4.91 (2.32–10.4) |
Zufferey et al. 2017 [7] | ACPA- and RF- inflammatory polyarthralgia > 6 weeks (secondary care) | 80 | 77 | 51 ± 14 | NP | RA | 18 ± 7 | 7 (8.8) | 18 | NP | Gender Elevated CRP | SONAR > 8/22⌃: OR 7.45 (1.19–42.8) US score ≥ 2 joints with grade ≥ 2 synovitis⌃: OR 10.1 (1.1–49) |
Results
Selection and inclusion of articles
Quality assessment
Study characteristics
Acquisition of ultrasound
Study | Machine | Probe | Mode | Synovitis (scoring method) | Tenosynovitis (scoring method) | Erosion | Locations scanned | One side (1)/both sides (2) | Total number of joints | Volar/dorsal side | Cut-off/threshold def. “inflammation US score” | Positive “inflammation US score”, % total group (progressors, non-progressors) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Rakieh et al. 2015 [11] |
Philips ATL HDI 5000
|
12–5 MHz and 8–15 MHz
|
PDUS
|
ND
|
ND
|
Wrist
MCP I-V
PIP I-V
|
2
|
22
|
NP
|
PDUS ≥ 1
|
33.0 (44.0, 22.0)
| |
Nam et al. 2016 [10] |
Philips ATL HDI 5000 and General Electric S7
|
5–12 and 8–15 MHz (Philips); 6–15 MHz (GE)
|
GSUS and PDUS
| Yes (0–3; for both GSUS and PDUS) [22] |
ND
|
Yes (0/1)
|
Wrist
MCP I-V
PIP I-V
MTP I-V
|
2
|
32
|
Dorsal
|
None
|
GSUS = 0: 4.4 (1.8, 6.3)
GSUS = 1: 27.9 (21.1, 32.9)
GSUS ≥ 2: 67.6 (77.2, 60.8)
PDUS = 0: 66.9 (50.9, 78.5)
PDUS = 1: 18.4 (22.8, 15.2)
PDUS = 2: 14.7 (26.3, 6.3)
ERO = 0: 79.4 (64.9, 89.9)
ERO = 1: 20.6 (35.1, 10.1)
|
van der Ven et al. 2017 [8] |
Mylab 60 (Esaote, Genoa, Italy)
|
10–18 MHz
|
GSUS and PDUS
| Yes (0–3; for both GSUS and PDUS) [15] |
ND
|
ND
|
Wrist
MCP II-V
PIP II-V
MTP II-V
|
2
|
26
|
Dorsal
|
a. Positive synovitis: GSUS ≥ 2 and/or PDUS ≥ 1
b. PDUS score: ≥ 1
|
a. 35.6 (54.8, 31.5)
b. 14.9 (29.0, 11.9)
|
van de Stadt et al. 2010 [12] | Acuson Antares, premium edition (Siemens, Malvern, PA, USA) | 5–13 MHz | GSUS and PDUS | Yes (0–3; for both GSUS and PDUS) [13] | Yes (0–3) | ND | Only tender joints* | 2 | NA | Volar | PDUS ≥ 1 Joint effusion, synovitis, tenosynovitis ≥ 2 | GSUS synovitis ≥ 2: 12.5 (15.6, 11.6) GSUS effusion ≥ 2: 11.5 (17.7, 9.5) PDUS ≥ 1: 17.2 (22.2, 15.6) Tenosynovitis ≥ 2: 6.8 (8.9, 6.1) |
Pratt et al. 2013 [9] | Aplio Diagnostic Ultrasound System (Toshiba Medical Systems Corporation, Tochigi-Ken, Japan) | 12 MHz | GSUS and PDUS | ND | Yes (0–3) | MCP II-IV PIP II-IV MTP I-II | 2 | 16 | Dorsal and volar | GSUS: a. sum score ≥ 2; b. sum score/6 joints (worst hand) ≥ 2; c. number of joints ≥ 1: ≥ 3. PDUS: d. sum score ≥ 1; e. number of joints ≥ 1: ≥ 2 | a. 35.1 (56.2, 19.4) b. 29.6 (48.8, 15.0) c. 30.1 (50.6, 14.7) d. 29.0 (46.9, 15.7) e. 16.9 (29.6, 7.4) | |
Zufferey et al. 2017 [7] | Philips HD 11 | 7–13 MHz | GSUS | ND | ND | Wrist MCP II-V PIP II-V Elbows Knees | 2 | 22 | NP | a. B-mode score > 8 (of total possible score of 66). b. ≥ 2 joints (of total number of 22 joints) with grade ≥ 2 synovitis [18] | a. 21.3 (57.1, 17.8) b. 25.0 (71.4, 20.5) |