Discordances between clinical and ultrasound measurements of disease activity among RA patients followed in real life.

Zufferey, Pascal; Courvoisier, Delphine S; Nissen, Michael J; Möller, Burkhard; Brulhart, Laure; Ziswiler, Hans Ruedi; Tamborrini, Giorgio; Ciurea, Adrian; D'Agostino, Maria-Antonietta; Finckh, Axel (2020). Discordances between clinical and ultrasound measurements of disease activity among RA patients followed in real life. Joint bone spine, 87(1), pp. 57-62. Elsevier 10.1016/j.jbspin.2019.09.010

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OBJECTIVE Measurements of disease activity, such as the clinical disease activity score (DAS28) or ultrasound (US) scores, often yield discordant results. This study's objectives were to determine the proportion of disagreements between the two assessment methods in patients with rheumatoid arthritis (RA) and to describe factors associated with discrepancy in assessment. METHODS All RA patients in the Swiss registry for inflammatory arthritides (SCQM) with at least one concomitant DAS28 and US score, were included. Disease activity was categorized as remission, low-to-moderate, and high, based on previously established cut-offs, for both the DAS28 and the US score. A longitudinal analysis was performed among patients who underwent at least two assessments. RESULTS Of 2369 assessments included (1091 patients), 1196 (50.4%) were discordant. The US score both over- and under-estimated disease activity compared to the DAS28 score (23.5% and 26.8% respectively). Clinical and demographic factors significantly associated with discordant results were the individual components of the DAS28 score when US was used as the reference and age, disease duration, and the swollen joint count when the DAS28 was used as the reference. The main US-related factor associated with discordance was the presence of US tenosynovitis. In the longitudinal analysis of 1081 patients, the proportion of disagreements remained essentially unchanged. CONCLUSION Rates of disagreement between clinical and US assessments of disease activity among RA patients are high and remain high during follow-up, even when the US assessors were aware of the clinical examination findings. Both clinical- and ultrasound- related factors were associated with discordances.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology

UniBE Contributor:

Möller, Burkhard


600 Technology > 610 Medicine & health








Burkhard Möller

Date Deposited:

08 Nov 2019 08:42

Last Modified:

15 Jan 2020 01:32

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Clinical evaluation Discordances Disease activity Rheumatoid arthritis Ultrasound





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