Abstract
ObjectivesAssessing disease activity in rheumatoid arthritis (RA) patients requires comprehensive quantification of tender and swollen joints. We aimed to evaluate the correlation and agreement between rheumatologists after a training session dedicated to the standardization of synovitis assessment and compare its performance with a reference imaging modality such as musculoskeletal ultrasonography (MSUS).MethodsIn this cross-sectional study, a total of 28 and 10 joints in RA patients were evaluated by physical examination and ultrasound (US), respectively. After participating in a training session, individual joint assessment for tenderness and swelling was performed by three rheumatologists. MSUS examination was performed separately by an experimented radiologist in a standardized manner, evaluating findings according to the Outcome Measures in Rheumatology Clinical Trial (OMERACT) guidelines.ResultsA total of 80 RA patients were included, with a mean Disease Activity Score based on 28 joints (DAS28)-ESR of 4.02. The interobserver overall agreement and concordance rate in a total of 2240 joints assessed was 81.7% (k = 0.449, p < 0.0001) for tender joints and 66% (k = 0.227, p < 0.0001) for swollen joints. The overall concordance rate was fair (Fleiss' kappa = 0.21, p = 0.027) with an overall agreement of 67.18% yet, more joints were found to be swollen by the US assessment, compared to the physical examination (43% vs 39%).ConclusionIn our study population, joint tenderness showed better interobserver agreement, correlation, and concordance rate than joint swelling. When comparing the US assessment to the physical examination, a fair overall concordance rate supports the need for the implementation of training sessions dedicated to standardization in rheumatology clinics.
Highlights
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by hyperplasia and inflammation of synovial tissue with subsequent bone erosion and loss of joint space with a noteworthyQuintana‐López et al Advances in Rheumatology (2021) 61:68 association on functionality and quality of life [1]
The following data were registered at baseline: age, gender, treatment, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), global health assessed by the patient (GH), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI)
Compared with tenderness, swelling assessment showed a slight strength of agreement with lower percentage of overall agreement and concordance rates (66% and Fleiss kappa = 0.227; 95% CI 0.203–0.250, p < 0.0001 vs 81.7% and Fleiss kappa = 0.449; 95% CI 0.403–0.493, p < 0.0001)
Summary
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by hyperplasia and inflammation of synovial tissue with subsequent bone erosion and loss of joint space with a noteworthyQuintana‐López et al Advances in Rheumatology (2021) 61:68 association on functionality and quality of life [1]. Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by hyperplasia and inflammation of synovial tissue with subsequent bone erosion and loss of joint space with a noteworthy. In order to assess disease activity in RA patients, there is not an individual parameter to be used. It is necessary to achieve a comprehensive approach through the use of several individual clinical and or laboratory parameters and to develop quantitative indexes to be used in daily clinical practice by rheumatology health professionals [2,3,4]. Among the most commonly used methods, the Disease Activity Score (DAS), and its modified version, DAS28, are based on a tender and swollen joint count, combined with other parameters such as a patient global health assessment [4, 5]. The examination technique should include exerting continuous and direct pressure on an affected joint with the thumb and index fingers until the examiner’s nail bed turns pale; this compares with a pressure of approximately 4 kg/cm2 [6, 7]
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