Background
Musculoskeletal ultrasound (US) is a valuable imaging tool in rheumatic diseases and has been increasingly used in rheumatologic practice and research in the last decade. Compared with clinical examination, grey scale ultrasound (GSUS) is a more sensitive method for detecting synovitis and tenosynovitis. Therefore, several ultrasound scores, mainly for RA, have been introduced recently to estimate the inflammatory activity and the therapeutic response. So far, mostly small joints such as the MCP-, PIP-, MTP-joints and wrists were enrolled into the scanning protocols, being the most affected joints in RA. However, also large joints are frequently involved in the arthritic process particularly in spondyloarthritis (SpA). Concerning psoriatic arthritis (PsA), the majority of publications have focused on entheseal inflammation, while surprisingly few articles have reported on synovial inflammation or hyperemia, which are characteristic features of large joint involvement in this condition. In ankylosing spondylitis (AS) typically affecting the spine, the most frequent single peripheral manifestation is peripheral arthritis (46.6%), followed by enthesitis (9.8%) and dactylitis (1.9%). GSUS and power Doppler ultrasound (PDUS) exhibit a higher sensitivity in detecting inflammation of large joints compared with clinical examination. Despite this fact, no US score for large joint involvement has been yet developed for PsA and AS. Therefore, the main focus of this project was the establishment of an US score for large joints, as recently published by our group for rheumatoid arthritis (RA), in patients with PsA and AS, suitable for daily rheumatologic practice.
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