Hindawi Publishing Corporation International Journal of Rheumatology Volume 2013, Article ID 493848, 9 pages http://dx.doi.org/10.1155/2013/493848 Research Article Detailed Joint Region Analysis of the 7-Joint Ultrasound Score: Evaluation of an Arthritis Patient Cohort over One Year S. Ohrndorf, 1 B. Halbauer, 1 P. Martus, 2 B. Reiche, 1 T. M. Backhaus, 3 G. R. Burmester, 1 and M. Backhaus 1 1 Department of Rheumatology and Clinical Immunology, Charit´ e-Universit¨ atsmedizin Berlin, 10117 Berlin, Germany 2 Department of Applied Biostatistics, UKT, University of T¨ ubingen, 71070 T¨ ubingen, Germany 3 Department of Medicine III, Nephrology and Rheumatology, Universit¨ atsklinikum UKE, 20246 Hamburg, Germany Correspondence should be addressed to M. Backhaus; marina.backhaus@charite.de Received 3 April 2013; Accepted 7 June 2013 Academic Editor: Mandana Nikpour Copyright © 2013 S. Ohrndorf et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. Te main objective of this study was to evaluate the 7-joint ultrasound (US7) score by detailed joint region analysis of an arthritis patient cohort. Methods. Te US7 score examines the clinically most afected wrist, MCP and PIP II, III, MTP II, and V joints for synovitis, tenosynovitis/paratenonitis, and erosions. Forty-fve patients with rheumatoid arthritis (RA) (84.4%) and spondyloarthritis with polyarticular peripheral arthritis (PsA 13.3%; AS 2.2%) with a median disease duration of 6.5 yrs (range 7.5 mths–47.6 yrs) were included and examined at baseline and 3, 6, and 12 months afer starting or changing therapy (DMARD/biologic). In this study, detailed US7 score joint region analysis was frstly performed. Results. Te joint region analysis performed at baseline disclosed synovitis in 95.6% of afected wrists in the dorsal aspect by greyscale (GS) US where Grade 2 (moderate) was most ofen (48.9%) detected. Palmar wrist regions presented Grade 1 (minor) capsule elevation in 40% and Grade 2 (moderate synovitis) in 37.8%. Tenosynovitis of the extensor carpi ulnaris (ECU) tendon was found in 40%, with PD activity in 6.6%. Most of the erosions in MCP II were detected in the radial (68.9%), followed by the dorsal (48.9%) and palmar (44.4%) aspects. In MTP V, erosions were seen in 75.6% from lateral. Conclusions. Synovitis in GSUS was more ofen detected in the wrist in the dorsal than in the palmar aspect. ECU tendon involvement was frequent. Most erosions were found in the lateral scan of MTP V and the medial (radial) scan of MCP II. 1. Introduction Objective imaging modalities are needed to detect the infammatory and destructive processes in arthritic diseases such as rheumatoid arthritis (RA) and seronegative spondy- loarthritis (e.g., psoriatic arthritis). In recent years, there have been numerous studies reporting early detection of sof tissue and bone processes in arthritic diseases and a high level of sensitivity in musculoskeletal ultrasonography (US) [1–8]. Tis imaging method allows disease activity and therapeutic response to be detected objectively and for immunosuppressive therapy to be adapted accordingly. As a result, better rheumatic disease outcomes might be achieved and structural damage prevented at earlier stages [9–13]. Due to rapid technical improvements, US has become the “extended diagnostic fnger” in the rheumatologist’s daily practice with high patient acceptability. Terefore, accurate assessment of joint infammation such as synovitis and bone processes is extremely important and standardization is, therefore, essential. Recently, a novel 7-joint US (US7) score for use in daily rheumatologic practice has been developed which includes examination of the clinically most afected wrist, MCP II, III, PIP II, III, MTP II, and V, that is, the joints that are most frequently involved in RA [14, 15]. Tey are assessed for synovitis, tenosynovitis/paratenonitis, and erosions according to the EULAR criteria [16] and the OMERACT defnition [17] including greyscale (GS) and power Doppler (PD) US. Synovitis and synovial/tenosynovial vascularity are scored semiquantitatively (grade 0–3) by PDUS according to Szkudlarek et al. [18]. Synovitis (efusion and synovial hypertrophy combined) in GSUS is analyzed semiquantitatively as described by Scheel et al. [19].