Patient_Reported_Outcome_Measures_in_Rheumatic_Diseases

425

validity was depicted in patients presenting with early infl ammatory arthritis where
progression of the patient’s functional disability over a short period of time was
predictive of persistent infl ammatory arthritis status [ 52 ]. Similarly, deterioration of
the patient’s functional disability correlated signifi cantly with the progression of the
patient’s joint damage [ 53 ]. Moreover, functional disability has been used to evalu-
ate response to therapies and is a prerequisite for proving that a drug has disease-
controlling capacity [ 54 , 55 ]. In concordance, several other studies revealed that US

Table 18.1 MSUS joint sonopathologic defi nitions and examples

Synovial fl uid (effusion)

(2005 OMERACT)

Abnormal hypoechoic or anechoic intra-articular material that is

displaceable and compressible but does not exhibit Doppler signal

Synovial hypertrophy

(2005 OMERACT)

Abnormal hypoechoic intra-articular tissue that is non-

displaceable and poorly compressible and which may exhibit

Doppler signal

Tenosynovitis (2005

OMERACT)

Hypoechoic or anechoic thickened tissue with or without fl uid

within the tendon sheath, which is seen in two perpendicular

planes and which may exhibit Doppler signal. And may be

accompanied by structural tendon lesions

Intra-articular erosion

(2005 OMERACT)

An intra-articular discontinuity of the bone surface that is visible

in two perpendicular planes

Cartilage damage (2005

OMERACT)

Loss of normal anechoic echostructure, and/or loss of sharpness of

at least one margin, and/or irregularity of the superfi cial margin,

and/or thinning of the cartilage layer

Enthesopathy (2005

OMERACT)

Abnormally hypoechoic and/or thickened tendon or ligament at its

bony attachment (may occasionally contain hyperechoic foci

consistent with calcifi cation), seen in two perpendicular planes

that may exhibit Doppler signal and/or bony changes including

enthesophytes, erosions, or irregularity

Enthesial

hypoechogenicity (2014

OMERACT)

Lack of the homogeneous fi brillar pattern with loss of the tightly

packed echogenic lines after correcting for anisotropy

Enthesial increased

thickness (2014

OMERACT)

Increased thickness of the tendon/ligament/capsule insertion into

the bone, as compared to the body of the tendon/ligament/capsule,

with or without blurring of the tendon/ligament/capsule margins

Enthesophyte (2014

OMERACT)

A step up of bony prominence at the end of the normal bone

contour, seen in two perpendicular planes, with or without

acoustic shadow

Enthesial calcifi cations Hyperechoic (bright) foci consistent with calcifi c deposits, with or

without acoustic shadow, seen in two perpendicular planes,

detected at the tendon insertion into the bone

Enthesial erosion Cortical breakage with a step down contour defect, seen in two

perpendicular planes, at the insertion of the enthesis to the bone

Enthesial Doppler signal Doppler activity approximately < 2 mm near the bony cortex. The

Doppler signal must be at the enthesis, different from refl ecting

surface artifact or nutrition vessel signal, with or without cortical

irregularities, erosions, or entesophytes

18 PROMs and Musculoskeletal Ultrasonography