Background/Purpose: Ultrasonography (US) has been prevalently used as a valid and objective modality for joint examination in patients with rheumatoid arthritis (RA). This study aimed to examine and compare the concordance between joint symptom, tenderness, or swelling and US synovitis.

Methods: Fifty patients with RA (84% female; median age, 69 years; disease duration, 2.4 years; disease activity score of 28 joints, 3.84) completed the self-evaluation of joint symptoms including pain and considerable stiffness in the (proximal) interphalangeal, metacarpophalangeal, wrist, elbow, shoulder, knee, and ankle joints. These joints were also subjected to physical examination by a physician to evaluate for the presence of tenderness and/or swelling, and to US examination for the presence of synovitis defined as gray-scale score ≥2 or power Doppler signal score ≥1.

Results: In a total of 1492 evaluated joints, symptoms, tenderness, and swelling were observed in 288 (19.3%), 182 (12.2%), and 220 (14.7%) joints, respectively, and US synovitis was observed in 317 (21.2%) joints. The overall concordance rate with US synovitis was the least for joint tenderness (κ = 0.30) when compared with joint symptoms (κ = 0.39) or swelling (κ = 0.43). Furthermore, US synovitis joint count of 28 joints showed a better correlation with swollen joint count (r²=0.53, p<0.0001) and with symptomatic joint count (r²=0.54, p<0.0001) than with tender joint count (r²=0.29, p<0.0001).

Conclusion: Joint swelling and patient-reported joint symptoms showed better concordance with US synovitis than joint tenderness.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/concordance-between-ultrasound-joint-synovitis-and-clinical-joint-assessments-by-patients-or-physicians-in-rheumatoid-arthritis/