Ultrasound interpretation

We used current OMERACT (Outcome Measures in Rheumatology) definitions for ultrasonographic pathology and elementary lesions for rheumatic disorders (19). In addition, images were scored for synovitis on grayscale (GS) and PD according to the EULAR-OMERACT scoring system, which divides the severity of synovitis and intensity of PD signals from normal (grade 0) to severe (grade 3) (20). An overall GS and PD signal score was calculated as the sum of GS synovitis, PD synovitis and GS tenosynovitis and PD tenosynovitis with the range of scores of 0–36 for GS synovitis, 0–36 for PD synovitis, 0–12 for GS tenosynovitis and 0–12 for PD tenosynovitis.

Finally, in our study, the definition of disease severity is based on the concepts of disease activity using activity indexes (DAS28-CRP, CDAI, SDAI), cardiovascular risk and ultrasonographic evaluation (synovitis in GS and PD, and structural damage/erosions).