Szkudlarek et al developed a semiquantitative scale for describing ultrasonographic changes seen in joints affected by rheumatoid arthritis. The authors are from the University of Copenhagen Hvidovre and Herlev Hospitals.
Parameters:
(1) joint effusion (compressible anechoic intracapsular area)
(2) synovitis (noncompressible hypoechoic intracapsular area indicative of synovial thickening)
(3) bone erosions
(4) power Doppler signal (representing blood flow in the synovium)
(5) tenosynovitis (hypoechoic or anechoic thickened tissue with or without fluid within the tendon sheath)
|
Parameter |
Finding |
Grade |
|
joint effusion |
no effusion |
0 |
|
|
minimal amount of effusion |
1 |
|
|
moderate amount without distension of the joint capsule |
2 |
|
|
extensive amount with distension of the joint capsule |
3 |
|
synovitis |
none (normal) |
0 |
|
|
minimal (fills the angle between the periarticular bones without bulging over the line linking the tops of the bones) |
1 |
|
|
moderate (bulging over the line linking tops of the periarticular bones without extending over the diaphyses) |
2 |
|
|
marked (bulging over the line linking tops of the periarticular bones and with focal extension to one or more diaphyses) |
3 |
|
bone erosions |
none (regular bone surface) |
0 |
|
|
irregular bone surface without formation of a defect seen in two planes |
1 |
|
|
bone defect seen in two planes |
2 |
|
|
bone defect associated with extensive bone destruction |
3 |
|
power Doppler signal |
no flow in the synovium |
0 |
|
|
single vessel signals |
1 |
|
|
confluent vessel signals in less than half of the synovial area |
2 |
|
|
confluent vessel signals in more than half of the synovium |
3 |
|
tenosynovitis |
no thickening |
0 |
|
|
minimal thickening |
1 |
|
|
moderate thickening |
2 |
|
|
extensive thickening |
3 |
where:
• The scale for tenosynovitis is described by van de Stadt et al.
|
Parameter |
Normal or Probably Normal |
Pathologic |
|
joint effusion |
0 or 1 |
2 or 3 |
|
synovitis |
0 or 1 |
2 or 3 |
|
bone erosion |
0 or 1 |
2 or 3 |
|
power Doppler signal |
0 |
1, 2 or 3 |
|
tenosynovitis |
0 or 1 |
2 or 3 |
Purpose: To describe ultrasonographic changes in a joint affected by rheumatoid arthritis using the scales of Szkudlarek et al.
Specialty: Immunology/Rheumatology
Objective: imaging studies, severity, prognosis, stage, disease progression
ICD-10: M05, M06,
