Abstract
BackgroundUltrasound (US) is sensitive for detecting joint and tendon inflammation in patients with rheumatoid arthritis (RA). So far, which grade of abnormalities on US corresponds to clinical manifestations is unclear. This study aimed to investigate the agreement between US-detected joint inflammation and clinical signs (joint swelling and tenderness).MethodsIn this cross-sectional study, 22 joints of the wrists and hands were, respectively, evaluated by physical examination (PE) and ultrasound in RA patients. Gray scale (GS) and power Doppler (PD) of synovitis, detected by ultrasound, were graded by semi-quantitative scoring systems (0–3). Tenosynovitis and peritendinitis were assessed qualitatively (0/1).ResultsA total of 258 consecutive RA patients were included, with median disease duration of 57 months and mean Disease Activity Score based on 28 joints (DAS28)-ESR/DAS28-CRP of 4.47/3.99. In a total of 5676 joints assessed, the overall concordance rate between positive clinical signs and ultrasound-determined joint inflammation was fair (κ = 0.365, p < 0.01). In wrists, joint tenderness showed higher κ coefficient (κ = 0.329, p < 0.01) with ultrasound-determined joint inflammation than swelling (κ = 0.263, p < 0.01); however, swelling showed higher κ coefficient (κ = 0.156–0.536, p < 0.01) with ultrasound-determined joint inflammation than tenderness (κ = 0.061–0.355, p < 0.01) in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Synovitis had consistently higher agreement with tenderness and swelling than tenosynovitis/peritendinitis. Tenderness and swelling had the highest κ coefficient with GS ≥ 1 synovial hyperplasia in most MCP and PIP joints, while with GS ≥ 2 synovial hyperplasia in wrists. For all 22 joints, PD ≥ 1 synovitis had the highest κ coefficient with clinical tenderness and swelling.ConclusionsSynovitis had better agreement with clinical signs than tenosynovitis/peritendinitis. Joint swelling showed better agreement with US-determined inflammation than tenderness for MCP and PIP joints, while the opposite for wrists. Both tenderness and swelling are more likely to correspond to GS ≥ 2 for wrists, GS ≥ 1 for MCP and PIP joints, and PD ≥ 1 for any joint.
Highlights
Ultrasound (US) is sensitive for detecting joint and tendon inflammation in patients with rheumatoid arthritis (RA)
Rheumatoid arthritis (RA) is an inflammatory disease characterized by chronic intra-articular and peri-articular synovial inflammation associated with joint destruction and function impairment [1]
Swollen and tender joint counts are essential parameters to access clinical disease activity and further formulate the treatment target in RA patients, including the Disease Activity Score based on 28 joints (DAS28) [2], Clinical Disease Activity SDAI Simplified Disease Activity Index (Index) (CDAI), Simplified Disease Activity Index (SDAI) [3], American College of Rheumatology (ACR) response criteria [4], and the new Boolean-based remission criteria [5], in both clinical practice and trials
Summary
Ultrasound (US) is sensitive for detecting joint and tendon inflammation in patients with rheumatoid arthritis (RA). Patients with RA have polyarthritis appearing as joint swelling and tenderness These signs are identified as joint inflammation by clinicians through physical examination (PE). Several single-center studies and metaanalyses have demonstrated a predictive value of PD positivity for flare and progressive bone erosion in patients with RA [12,13,14,15]. It remains unclear which grade of GS indicates a pathological finding [16,17,18,19,20]
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