Table 1.

Sonographic evaluation: scanning technique and scoring of synovitis. Synovitis was defined as at least grade 1 by both B-mode and power Doppler.

Joint, and Type of SonographyScanning Technique and Scoring System
Glenohumeral jointPresence or absence of fluid and/or of hypoechoic synovial hypertrophy in the bicipital groove, transducer transversal and longitudinal to the anterior part of the humerus, shoulder in neutral position. Axillary recess, longitudinal scan.
ElbowTransverse anterior scan and posterior scan with elbow flexed at 90°: presence or absence of fluid and/or of hypoechoic synovial hypertrophy from the humeral capitellum or the coronoid fossa to the joint capsule.
WristLongitudinal and transversal, from the dorsal aspect with the joint in neutral position, probe located on the 3rd finger: presence or absence of fluid and/or of hypoechoic synovial hypertrophy from the bones to the joint capsule.
5 MCP and 5 PIPLongitudinal scanning of the dorsal MCP and PIP joints in extension: presence or absence of fluid and/or of hypoechoic synovial hypertrophy from the articular bony margin to the joint capsule.
KneeLongitudinal and transversal, from the suprapatellar recess, in a supine position, with the joint in 30° of flexion: presence or absence of fluid and/or of hypoechoic synovial hypertrophy in the anteroposterior diameter of the suprapatellar recess.
B-modeGrade 0 o normal: normal joint (no synovial hypertrophy, no joint effusion)
Grade 1 or minimal: minimal synovitis (minimal synovial hypertrophy, with or without minimal joint effusion)
Grade 2 or moderate: moderate synovitis (moderate synovial hypertrophy with or without minimal or moderate joint effusion)
Grade 3 or severe: severe synovitis (severe synovial hypertrophy, with or without severe joint effusion)
Power DopplerGrade 0: no vessel in the synovium
Grade 1: up to 3 discrete spots or 1 confluent spot + up to 2 discrete spots
Grade 2: vessel signals in less than 50% of the surface area of the synovium
Grade 3: vessel signals in more than 50% of the surface area of the synovium
  • MCP: metacarpophalangeal joints; PIP: proximal interphalangeal joints.