Clinical versus Ultrasound Examination to Detect Synovial Effusion of the Wrist in a Patient with Rheumatoid Arthritis

Abstract

Objectives: The aim of this study is to understand whether or not, and to what extent, clinical examination (CE) of joint involvement in rheumatoid arthritis depends on clinical experience and whether or not, despite clinical experience, ultrasound examination provides more accurate results than CE. Methods: 51 rheumatologists with different professional experience measured in years since MD graduation. All clinicians studied the same patient and they evaluated the wrists and indicated the presence/absence of swelling and its extent (mild, moderate, severe). Three experienced sonographers blinded to clinical findings each performed ultrasound (US) examination of the patient's wrists. Results: US analysis showed that the patient’s right wrist had moderate joint effusion, whereas the left wrist had mild joint effusion; similar results were obtained with power Doppler imaging of both wrists. Only about 50% of the clinicians involved recognized joint effusion in both wrists. The CE findings were independent of clinical experience. The results of CE were coherent with US evaluation only in a percentage of 23%. Conclusions: This study underscores again the superiority of US in the assessment of inflammatory processes and the inaccuracy of CE, even if performed by rheumatologists with extensive professional experience.