Joint Involvement In Rheumatoid Arthritis Research Articles

Distal interphalangeal joint involvement in patients with rheumatoid arthritis: Where are we?

Rheumatoid arthritis (RA) usually affects the wrist, metacarpophalangeal joint, and proximal interphalangeal joint of the hands. However, the distal interphalangeal (DIP) joints may also be involved in RA patients. In this study, we aimed to evaluate the frequency and associated factors of DIP joint erosion in patients with RA. Medical records of patients with RA were reviewed retrospectively. Patients with major trauma affecting DIP joints, osteoarthritis, erosive osteoarthritis, psoriatic arthritis, systemic sclerosis, calcium pyrophosphate dihydrate disease, and gout were excluded. Anteroposterior hand X-rays were evaluated and patients were divided into groups according to autoantibody profile. We reviewed 1213 patients with a mean age of 54.3 ± 12.5 years; 82.8% of them were female, and 95.4% had RA-type erosive changes. The DIP erosion rate was 12%. DIP involvement was generally unilateral and asymmetric, with the 3rd finger being the most commonly affected joint. Patients with DIP erosions had a significantly longer disease duration (p = 0.036). Older age was an independent predictive factor for DIP erosion (p = 0.001). In this large-sample study, we reported DIP joint involvement in patients with RA. Advanced age could have affected the results because hand erosions increase above 50 years in a healthy population. Our results may provide a different perspective on joint involvement in RA.

Joint-specific rheumatoid arthritis fibroblast-like synoviocyte regulation identified by integration of chromatin access and transcriptional activity.

The mechanisms responsible for the distribution and severity of joint involvement in rheumatoid arthritis (RA) are not known. To explore whether site-specific fibroblast-like synoviocyte (FLS) biology might be associated with location-specific synovitis and explain the predilection for hand (wrist/metacarpal phalangeal joints) involvement in RA, we generated transcriptomic and chromatin accessibility data from FLS to identify the transcription factors and pathways. Networks were constructed by integration of chromatin accessibility and gene expression data. Analysis revealed joint-specific patterns of FLS phenotype, with proliferative, migratory, proinflammatory, and matrix-degrading characteristics observed in resting FLS derived from the hand joints compared with hip or knee. TNF stimulation amplified these differences, with greater enrichment of proinflammatory and proliferative genes in hand FLS compared with hip and knee FLS. Hand FLS also had the greatest expression of markers associated with an "activated" state relative to the "resting" state, with the greatest cytokine and MMP expression in TNF-stimulated hand FLS. Predicted differences in proliferation and migration were biologically validated with hand FLS exhibiting greater migration and cell growth than hip or knee FLS. Distinctive joint-specific FLS biology associated with a more aggressive inflammatory response might contribute to the distribution and severity of joint involvement in RA.

The assessment of atlantoaxial joint involvement in patients with rheumatoid arthritis, results from an observational “real-life” study

Atlantoaxial joint is a possible affected site during rheumatoid arthritis (RA) and, in this work, we evaluated its occurrence and associated characteristics in a “real-life” cohort. By a medical records review study of RA patients longitudinally followed-up, the occurrence of severe atlantoaxial joint involvement was estimated (incidence proportion and incidence rate per 1000 person-years at risk). Regression analyses were also exploited to evaluate possible associated factors. Based on these findings, a prospective recruitment was performed to build a descriptive cross-sectional study in evaluating a subclinical atlantoaxial joint involvement in patients with the same clinical characteristics. Retrospectively, 717 patients (female 56.6%, age 64.7 ± 12.3 years) were studied. The incidence proportion of severe atlantoaxial joint involvement was 2.1% [1.5–2.5], occurring in 15 out of 717 patients, and identified by both MRI and CT scan. Considering over 3091 person-years, an incidence rate of 5.2 × 1000 [2.9–8.3] person-years was estimated. Regression analyses suggested that male gender, a longer disease duration, ACPA positivity and extra-articular manifestations resulted to be significantly associated with a severe atlantoaxial joint involvement. Given these findings, 30 asymptomatic patients were selected according to these clinical characteristics and underwent MRI of cervical spine. To date, almost 50% of these asymptomatic patients showed a subclinical atlantoaxial joint involvement. The occurrence of the severe atlantoaxial joint involvement in RA patients was estimated in a “real-life” setting. Male gender, ACPA positivity, long disease duration, and extra-articular manifestations could be associated with the severe atlantoaxial joint involvement in RA. MRI could provide a useful clinical tool to early evaluate the atlantoaxial joint involvement in RA, also in asymptomatic patients.

Joint involvement in RA starts predominantly in the hands: functional, clinical and imaging studies in clinically suspect arthralgia and during progression to RA

ObjectivesIt is unknown whether rheumatoid arthritis (RA) starts in hands or feet. To investigate this, we performed functional, clinical and imaging studies during progression from clinically suspect arthralgia (CSA) to...

Subclinical hip involvement in rheumatoid arthritis. An ultrasound assessment

IntroductionHip joint involvement in rheumatoid arthritis has been related to disability and lower quality of life. Currently, not enough studies provide information for subclinical hip involvement. ObjectivesTo determine the prevalence of subclinical hip joint involvement in rheumatoid arthritis, characterizing it by ultrasound. Materials and methodsA descriptive cross-sectional study in rheumatoid arthritis patients with an established diagnosis of rheumatoid arthritis according to EULAR/ACR 2010 classification criteria, without hip pain or abnormalities during a clinical examination (subclinical group), this group was compared with a group of symptomatic patients with rheumatoid arthritis of the hip (pathological control group), and with healthy control individuals matched by age and body mass index. The presence of joint capsule distension, osteophytes, joint remodelling process, erosions, iliopsoas bursitis, and power Doppler signal was assessed. The images were interpreted by an experienced rheumatologist blinded to clinical and laboratory variables. Results234 hips were studied; 37 (31.6%) symptomatic hip patients, 40 (34.1%) asymptomatic hip patients and 40 (34.1%) healthy individuals. The prevalence of joint capsule distension was 20%, while symptomatic hip patients and healthy individuals had a prevalence of 48.6% and 15%, respectively. The asymptomatic group presented higher values for osteophytes and joint remodelling. ConclusionsUltrasound is a sensitive tool to identify subclinical hip joint synovitis in rheumatoid arthritis patients, reaffirming the value of ultrasound in preclinical diagnosis. The presence of erosions and iliopsoas bursitis was low; we observed no power Doppler signals nor significant associations between ultrasound findings with disease activity and laboratory test results.

Temporomandibular joint involvement in elderly onset and young onset rheumatoid arthritis patients.

There are studies showing clinical and laboratory differences between elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis. Temporomandibular joint involvement in rheumatoid arthritis is not rare. In this study, we aimed to examine the temporomandibular joint involvement and magnetic resonance imaging findings in elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis patients. A total of 87 rheumatoid arthritis patients were investigated retrospectively. The onset ≥60 years was considered elderly-onset rheumatoid arthritis. Erosion, flattening, and resorption of the condyle, narrowing of the joint space, joint effusion, synovial hypertrophy, and synovitis were interpreted as temporomandibular joint involvement with magnetic resonance imaging. Patients' age, gender, rheumatoid factor, and anti-cyclic citrullinated peptide positivity, extra-articular findings, medical treatment, and disease activity score were noted. A total of 15 (17.2%) patients had elderly-onset rheumatoid arthritis. Temporomandibular joint involvement was detected in 67 (77%) patients; 9 (60%) of them were in the elderly-onset rheumatoid arthritis group (n=15) and 58 (80.6%) of them were in the young-onset rheumatoid arthritis group (n=72). Patients with temporomandibular joint involvement were significantly higher than those without temporomandibular joint involvement in both the elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis groups (p<0.001). No significant difference was found between elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis for the temporomandibular joint involvement (p=0.100). In the young-onset rheumatoid arthritis group, rheumatoid factor positivity and anti-cyclic citrullinated peptide positivity were more frequent in the patients with temporomandibular joint involvement (p=0.011, p=0.024). A comparison of the elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis patients showed no significant difference in the magnetic resonance imaging findings except for the resorption of the condyle. According to our findings, elderly-onset rheumatoid arthritis is not much different from young-onset rheumatoid arthritis in terms of temporomandibular joint involvement, magnetic resonance imaging findings, and clinical and laboratory features.

EVALUATION OF HAND AND WRIST JOINTS USING ULTRASONOGRAPHY AND DOPPLER IN PATIENTS OF RHEUMATOID ARTHRITIS: COMPARISON WITH CONVENTIONAL RADIOGRAPHY AND CLINICAL CORRELATION

Background- Ultrasound (US) together with power Doppler (PD) are progressively being employed to assess joint involvement in rheumatoid arthritis (RA). High-resolution US permits direct assessment of intra-articular and periarticular inammatory activity and structural damage in inammatory arthritis. To analyze the quality of point-of-care hand and wrist ultra Objective- sound (US) examination in patients with established rheumatoid arthritis, it's comparison with standard radiography and clinical correlation. This prospective study was performed in 32 Methodspatients. Gray scale and power doppler ultrasonography of bilateral hand and wrist joint were performed employing a high-frequency linear transducer. Various ndings were recorded together with synovial hypertrophy, Power Doppler abnormality, soft tissue thickening, tendonitis, joint effusion, periosteal reaction, and erosions. Composite ultrasound scores and Disease Activity Score 28 were calculated and compared. ResultsUltrasound detected a lot of abnormalities within hand joints than the clinical examination. Synovial hypertrophy was detected altogether in 24 (75%) patients on gray scale ultrasound, active synovitis detected by using Doppler US in 20 patients (62.5%), effusion was detected in 10 patients (37.5 %), bone erosions (mostly in DIP and PIP joints) were detected in 20 patients (62.5%) and X-ray nding was detected in 8 patients (25%). There was a positive correlation of Power Doppler with synovial hypertrophy, bone erosions, Erythrocyte Sedimentation Rate and Disease Activity Score. Ultrasound could be a helpful reliable modality for the target assess Conclusion- ment of both soft tissue and erosive joint changes occurring in early stage in rheumatoid arthritis. Power doppler scores can be applied with bigger accuracy than clinical scores of synovitis in rheumatologic practice to enable therapeutic choices and to evaluate disease outcome and response to treatment.

Compromiso subclínico de cadera en artritis reumatoide. Un estudio ultrasonográfico

IntroductionHip joint involvement in rheumatoid arthritis has been related to disability and lower quality of life. Currently, not enough studies provide information for subclinical hip involvement. ObjectivesTo determine the prevalence of subclinical hip joint involvement in rheumatoid arthritis, characterizing it by ultrasound. Materials and methodsA descriptive cross-sectional study in rheumatoid arthritis patients with an established diagnosis of rheumatoid arthritis according to EULAR/ACR 2010 classification criteria, without hip pain or abnormalities during a clinical examination (subclinical group), this group was compared with a group of symptomatic patients with rheumatoid arthritis of the hip (pathological control group), and with healthy control individuals matched by age and body mass index. The presence of joint capsule distension, osteophytes, joint remodelling process, erosions, iliopsoas bursitis, and power Doppler signal was assessed. The images were interpreted by an experienced rheumatologist blinded to clinical and laboratory variables. Results234 hips were studied; 37 (31.6%) symptomatic hip patients, 40 (34.1%) asymptomatic hip patients and 40 (34.1%) healthy individuals. The prevalence of joint capsule distension was 20%, while symptomatic hip patients and healthy individuals had a prevalence of 48.6% and 15%, respectively. The asymptomatic group presented higher values for osteophytes and joint remodelling. ConclusionsUltrasound is a sensitive tool to identify subclinical hip joint synovitis in rheumatoid arthritis patients, reaffirming the value of ultrasound in preclinical diagnosis. The presence of erosions and iliopsoas bursitis was low; we observed no power Doppler signals nor significant associations between ultrasound findings with disease activity and laboratory test results.

Joint involvement in Rheumatoid arthritis: Sonographic evaluation in comparison with Radiography

Background: The aim of this study was to evaluate the role of ultrasonography (including power doppler) in assessing the joint involvement in Rheumatoid Arthritis (RA) and its comparison to radiographic changes. Materials and Methods: 55 patients with RA underwent ultrasound and radiographic examination of wrist and hand with laboratory investigations. 25 subjects were taken as controls. Following points were specifically looked in ultrasound – synovitis, synovial hypertrophy, effusion, cartilage thickness, swelling of tendon, osteophytes, erosions. Erosion sites were compared using radiographs. Ultrasonography was performed by two radiologists and inter-observer agreement was calculated. Results: Out of total 55 cases, 44 cases were classified as early RA and 11 cases as advanced RA. Out of 25 control subjects, 3 subjects had a lesion – atypical for RA, however – all 3 had previous trauma at that site. Inter-observer agreement was excellent. Intra-articular erosions were seen in all cases of advanced RA and in only 26/44 cases in early RA cases. Tenosynovitis was seen in 21/44 cases of early RA while only one case of advanced RA showed tenosynovitis. There was reduced cartilage thickness in all patients of advanced RA while none was observed in early RA cases. Synovial hypertrophy and synovial effusion were almost similar in both early and advanced RA cases. Ultrasonography detected erosions in 37/54 cases while radiography detected erosions in only 11/54 cases. Conclusions: Sonography can be used as a primary modality to diagnose RA especially early RA, which helps in reducing disabilities by early aggressive treatment. It is more sensitive than radiography in detecting erosions. Keywords: Erosions, Ultrasonography, Radiograph, Synovitis.

Tocotrienol-Rich Fraction Of Palm Oil Attenuates Type II Collagen-Induced Temporomandibular Joint Rheumatoid Arthritis In Rats For Future Clinical Application

Temporomandibular joint involvement in rheumatoid arthritis (RA) is not uncommon. Nonsteroidal anti-inflammatory drugs (NSAIDs), are considered main line of RA treatment but they can cause side effects. Tocotrienol rich fraction (TRF) extracted from palm oil was reported to possess potent antioxidant and anti-inflammatory activities. This research was designed to study the therapeutic potential of TRF against TMJ arthritis. 30 Albino Wistar rats were divided into: Control (C), Arthritis (A) and Arthritis + TRF (A-TRF) groups. A-TRF group received TRF daily from day 30 up to day 45 after TMJ arthritis induction was accomplished. Serum inflammatory cytokines were assessed and TMJ histopathological examinations were done. Plasma levels of inflammatory cytokines increased in A-group and they were comparable in both C and A-TRF groups. A-TRF group showed that, the inflammatory changes were mild on examination of stained sections of TMJ. A-TRF-group bone mineral density was notably increased after TRF administration. In conclusion, the decreased plasma levels of inflammatory cytokines and the increased bone mineral density associated with tocotrienolsrich-fraction supplements administration could be provide an evidence that TRF could be used as an effective therapy of TMJ rheumatoid arthritis.

The prevalence of temporomandibular joint involvement in rheumatoid arthritis patients: A cross-sectional study

Objectives: Temporomandibular joint (TMJ) involvement in rheumatoid arthritis (RA) patients has been described in the literature; however, its incidence varies greatly. In this study, we aimed to determine the prevalence and clinical characteristics of TMJ involvement in RA patients.Materials and Methods: The present study consisted of 60 individuals with RA. The patients were assigned to two groups, based on TMJ involvement: patients with TMJ involvement and patients without TMJ involvement. We defined TMJ involvement based on the findings of the questionnaires and clinical examination by a rheumatologist. The symptoms and signs were recorded by a single trained dentist.Results: The majority of the participants were women (n=49, 81.66%), with the mean age of 43.9±15.52 years (range: 21-78 years). Thirty-five patients (58.3%) had clinical evidence of TMJ involvement. The levels of C-reactive protein (CRP) and rheumatoid factor (RF) were found to be correlated with TMJ involvement. There was no significant correlation between TMJ involvement and erythrocyte sedimentation rate (ESR), age, gender, treatment duration, and disease duration.Conclusion: The high level of CRP in RA patients with TMJ involvement was reported. TMJ pain was reported in almost half of the patients. There was also a significant correlation between TMJ involvement and RF.

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

Correlation between Lung and Joint Involvement in Patients with Rheumatoid Arthritis and Interstitial Lung Disease: A Cross-Sectional Study.

Rheumatoid arthritis (RA) can affect the lungs in different manners, with interstitial lung disease (ILD) as the most serious manifestation. Although lung and joint compromise could be thought to evolve in parallel, there are data suggesting the opposite. In this study, we evaluated the relationship between lung and joint involvement in RA ILD. An observational cross-sectional study of RA ILD patients evaluated from January 2015 to February 2017. Joint disease assessment included number of tender and swollen joints, patient's global assessment of disease activity, erythrocyte sedimentation rate (ESR) or C-reactive protein, and disease activity score (DAS28). Lung disease assessment included forced vital capacity, diffusion capacity (DLCO), and Goh high-resolution computed tomography (HRCT) score for total extent, ground glass, and reticular pattern. We studied the correlation between both components of the disease. We included 46 patients, 14 (30.4%) men, with a mean (SD) of the age of 59.9 years (11.89). 12 (26.09) patients were in remission or had low disease activity measured with DAS28. The HRCT showed usual interstitial pneumonia (UIP) pattern in 10 (21.7%), possible UIP in 18 (39.1%), and inconsistent with UIP in 18 (39.1%). We found a good correlation between the ESR and the ground glass score in the HRCT (r = 0.39; p = 0.03). However, we found no correlation between lung function tests or HRCT scores and the other components of the DAS28. We only found a good correlation between ESR and ground glass score. It is possible that different pathways of the immune response mediate damage in lungs and joints.

The Pattern of Joints Involvement in Patients with Rheumatoid Arthritis in Rheumatology Clinic Dr. Hasan Sadikin General Hospital Bandung

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease with primary manifestation in the joints. Early management of RA will prevent further joint damage. The joint damages, result of uncontrolled disease activity, will decrease patient’s quality of life.RA should be diagnosed earlier and followed by early treatment initiation, in order to prevent further damages. This study aimed to determine the pattern of joint involvement in RA in order to made earlier diagnosis and treatment initiation.Method: This research was conducted using descriptive study design. Data were obtained using interview of RA patients who coming to Rheumatology Clinic of Dr. Hasan Sadikin General Hospital from August 2016 to October 2016. Collected data included number of joints involvement, duration of therapy, and duration of illness after diagnosed according to the criteria of ACR / EULAR 2010.Result: Ninety-seven RA patients were involved in this study. Subjects were dominantly women (87%), the highest age group was 45-49 years old (17.53%), duration of the disease &lt;5 years (90.72%), and duration of therapy &gt; 3 months (86%). Joint that frequently involved at the time when the diagnosis made was first proximal interphalangeal (49.50%), overall findings during the course of RA was the wrist joint (90.72%).There were different tendency of joint involvement between the gender, knee joints occured in 53,84% male subjects, while PIP joints were accounted for 52,38% infemale subjects.Conclusion: The first PIP was the most common joint involved in RA patients when the diagnosis made. The wrist joint involvement was dominantly found in overall course of RA. Knee joint involvement was majorly found in male RA patients, whereas female RA patients would suffer mostly from PIP joint involvement.Keywords: involvement pattern, joints, rheumatoid arthritis

Fractal analysis of subchondral bone changes of the hand in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disorder. Conventional radiography, a widely available and cost-effective examination method, remains the standard of reference for the detection and quantification of joint involvement in RA. Fractal dimension (FD) of the trabecular bone structure has been proven to correlate with the bone's physical properties. The present study was designed to use fractal analysis to validate radiograph changes in the hand of RA patients.This study retrospectively evaluated the hand radiographs of 108 subjects. Fifty-four patients were suffering from RA, of which 18 were men and 36 were women. Their ages ranged from 25 to 90 years. The hand radiographs of 54 healthy patients, 18 men and 36 women (age range 23–88 years), were used as the control group. Bone structure value (BSV) is a critical parameter for the assessment and analysis of bone microarchitecture. The BSVs were calculated over the fractal dimension using the Brownian motion.The BSV calculated for ROI showed a significant difference in ROI5 (0.210 ± 0.045), ROI6 (0.186 ± 0.066), and ROI11 (0.201 ± 0.056) in patients with RA, in comparison to the CG (P < 0.05). A significant correlation was observed between anti-CCP and ROI4, ROI5, ROI6, ROI9, and ROI12 in seropositive RA patients (post hoc test (Bonferroni) P <0.001).This study demonstrates that the bone textural image analysis technique can be used to quantify the radiographic changes in RA hands, based on comparisons of FDs.

Ultrasonographic evaluation of joint involvement in rheumatoid arthritis: Comparison with conventional radiography and correlation with disease activity parameters

Background: Ultrasound (US) including power Doppler (PD) are increasingly being used to evaluate joint involvement in rheumatoid arthritis (RA). Aim of this study was to evaluate joint involvement in RA by US including PD and gray scale imaging and its comparison with conventional radiographic changes and correlation with disease activity parameters. Methods: Patients with RA of less than 3.5 years disease duration were subjected to detailed clinical examination and laboratory investigations. After X-ray imaging (posterior-anterior view) of both hand joints, PD and gray scale US examination of 14 joints of both hands was performed and mean cumulative flow signal score (CFS) was calculated. Disease activity score (DAS28) was also calculated for each patient. Results: Out of total 57 patients evaluated, 54 had abnormal findings on US as compared to only 17 having radiographic abnormalities. US could detect erosions in 29 patients including all of the fourteen patients who had radiographically detectable erosions. On US evaluation, radiocarpal joint was involved most frequently. The mean CFS was 1.17 ± 1.64 in patients who were in remission (DAS28 5.1). The difference in CFS among these groups was statistically significant (P Conclusions: US detected CFS which an indicator of ongoing inflammation in RA patients with clinical remission (DAS28 <2.6). US is more sensitive than conventional radiography for detection of erosions. CFS on PD had a significant correlation with markers of disease activity.

Comment on “Ultrasonographic evaluation of joint involvement in rheumatoid arthritis: Comparison with conventional radiography and correlation with disease activity parameters”

Comment on “Ultrasonographic evaluation of joint involvement in rheumatoid arthritis: Comparison with conventional radiography and correlation with disease activity parameters”

Relationship between handedness and joint involvement in rheumatoid arthritis.

Rheumatoid arthritis (RA) is characterized by autoimmune chronic joint inflammation, which is worsened by mechanical stress. It is still inconclusive whether joints on the right side or the dominant side get more damaged in RA since the limited number of patients analyzed in the previous study had made it difficult to separately analyze right-handed and left-handed patients. Here, we enrolled 334 RA patients, the biggest number of patients in studies to address this issue and separately analyzed right-handed and left-handed patients. As a result, we observed that joints on the dominant side got clinically and radiologically more involved in the right-handed patients (p ≤ 0.0030). Importantly, this tendency was also seen in the left-handed patients, while it was not statistically significant due to the small sample size. This tendency was observed in each component of clinical or radiological involvement. Thus, handedness influences the laterality of clinical and radiological joint involvement in RA.

Patient and clinician views on the quality of foot health care for rheumatoid arthritis outpatients: a mixed methods service evaluation.

BackgroundFeet are often the first site of joint involvement in rheumatoid arthritis (RA) and get progressively worse if unmanaged, leading to permanent disability and negatively impacting patients’ quality of life. Podiatrists are specialists in the assessment, diagnosis and management of foot and ankle problems, however, RA outpatients often rely on referral from rheumatology clinicians to gain access to musculoskeletal podiatry services on the UK National Health Service (NHS). Therefore, the aim of this evaluation was to identify the foot health needs of rheumatoid arthritis patients and if they are being met by rheumatology clinicians.MethodsA mixed methods approach was used: collecting qualitative data from patients and quantitative data from clinicians. Two focus groups were conducted with nine RA patients from a tertiary rheumatology outpatient clinic in the UK and the data were thematically analysed to inform a clinician survey. Thirteen rheumatology clinicians, from the same centre, completed the online survey. Resultant data were analysed to produce descriptive statistics.ResultsPatient focus group data generated four main themes: (1) need for foot health information, (2) feet ignored during routine consultations, (3) frequency of foot examination and (4) access to podiatry. Survey data highlighted that (i) 69–85 % of clinicians provided patients with foot health information sometimes, (ii) feet were examined in 47 % of routine consultations, (iii) 54 % of clinicians did not examine feet routinely because they are not included in the disease activity score with 28 joints (DAS-28), (iv) 31 % of clinicians referred patients to podiatry upon RA diagnosis, (v) 0 % of clinicians referred patients to podiatry for periodic review, (vi) 54 % of clinicians believed patients will self-report foot problems and (vii) 62 % of clinicians felt competent in foot examination.ConclusionsRA patients’ foot health needs were not being fully met by rheumatology clinicians. Patients want foot health information and easy access to podiatry services. Rheumatology outpatient consultations need to have a wider focus than the DAS-28 and incorporate foot examination as standard. Clinicians need to ensure they have sufficient training and follow current national foot health guidance to provide optimal foot health care and outcomes for their RA patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0133-2) contains supplementary material, which is available to authorized users.

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

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.