Session Information
Date: Monday, October 22, 2018
Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster II: Diagnosis and Prognosis
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: We conducted this retrospective study to determine objective and comprehensive diagnostic criteria for early rheumatoid arthritis (RA) that are based on ultrasound (US) and serologic findings.
Methods: From August 2014 to May 2016, we recruited 216 consecutive patients at Hospital 1 and 223 consecutive patients at Hospital 2 who were suspected to have RA and underwent US of bilateral hands. The duration from the appearance of the patient’s symptoms to his or her entry into the study was ≤6 months. In the US of bilateral hands from 22 sites, the findings obtained by grayscale (GS) and power Doppler (PD) assessments were graded on a semi-quantitative scale from 0 to 3. We also examined the assessment of the novel Outcome Measures in Rheumatology (OMERACT)-European League Against Rheumatism (EULAR) combined power Doppler ultrasound (PDUS) score (i.e., the cPD score) and the Global OMERACT-EULAR Synovitis Score (GLOESS). The diagnostic performance of the patients was evaluated using US findings and the combination of US and serologic findings.
Results: Seventy patients (32.4%) at Hospital 1 and 59 patients (26.5%) at Hospital 2 were diagnosed as having RA. The best-balanced diagnostic performance at each hospital was achieved using a combination, such as (1) the presence of PD grade ≥2 articular synovitis or (2) the presence of PD grade ≥1 articular synovitis and serologic positivity, as well as (1) the presence of cPD grade = 3 or (2) a cPD grade ≥2 and serologic positivity (Table 1 and 2).
Conclusion: The combination of a PD assessment or the cPD score with the measurement of autoantibodies of rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies can accurately identify the patients with early RA.
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Table 1. Diagnostic performance of RA classification criteria, and serologic and ultrasound findings |
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Hospital 1 |
Hospital 2 |
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Sensitivity |
Specificity |
PPV |
NPV |
Accuracy |
Sensitivity |
Specificity |
PPV |
NPV |
Accuracy |
|
|
2010 ACR/EULAR criteria |
71.4 |
84.9 |
69.4 |
86.1 |
80.6 |
57.6 |
93.3 |
75.6 |
86.0 |
83.9 |
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Seropositivity |
|
|
|
|
|
|
|
|
|
|
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RF-positive |
75.7 |
78.1 |
62.4 |
87.0 |
77.3 |
74.6 |
73.1 |
50.0 |
88.9 |
73.5 |
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ACPA-positive |
64.3 |
90.4 |
76.3 |
84.1 |
81.9 |
67.8 |
92.1 |
75.5 |
88.8 |
85.7 |
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RF- and/or ACPA-positive |
77.1 |
73.3 |
58.1 |
87.0 |
74.5 |
78.0 |
70.7 |
48.9 |
89.9 |
72.3 |
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US findings |
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Articular synovitis |
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Synovial hypertrophy: |
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GS grade ≥1* |
98.6 |
31.5 |
40.8 |
97.8 |
53.2 |
89.8 |
62.8 |
46.5 |
94.5 |
70.0 |
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GS grade ≥2* |
85.7 |
85.6 |
74.1 |
92.6 |
85.6 |
79.7 |
79.9 |
58.8 |
91.6 |
79.8 |
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GS grade 3* |
44.3 |
97.9 |
91.2 |
78.6 |
80.6 |
5.1 |
98.8 |
60.0 |
74.3 |
74 |
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Vascularity: |
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PD grade ≥1* |
91.4 |
86.3 |
76.2 |
95.5 |
88.0 |
86.4 |
78.0 |
58.6 |
94.1 |
80.2 |
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PD grade ≥2* |
84.3 |
95.2 |
89.4 |
92.7 |
91.7 |
67.8 |
94.5 |
81.6 |
89.1 |
87.4 |
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PD grade 3* |
17.1 |
99.3 |
92.3 |
71.4 |
72.7 |
3.4 |
99.4 |
66.7 |
74.1 |
74.0 |
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Total PD score ≥2 |
88.6 |
90.4 |
81.6 |
94.3 |
89.8 |
79.7 |
90.9 |
75.8 |
92.5 |
87.9 |
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OMERACT-EULAR combined scoring system: |
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cPD grade ≥1* |
98.6 |
31.5 |
40.8 |
97.8 |
53.2 |
89.8 |
62.8 |
46.5 |
94.5 |
70.0 |
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cPD grade ≥2* |
90.0 |
86.3 |
75.9 |
94.7 |
87.5 |
81.4 |
79.9 |
59.3 |
92.3 |
80.3 |
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cPD grade 3* |
51.4 |
97.9 |
92.3 |
80.8 |
82.9 |
8.5 |
98.1 |
62.5 |
74.9 |
74.4 |
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Total cPD score ≥3 |
94.3 |
62.3 |
54.5 |
95.8 |
72.7 |
NT |
NT |
NT |
NT |
NT |
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GLOESS ≥2 |
78.6 |
68.5 |
54.5 |
87.0 |
71.8 |
NT |
NT |
NT |
NT |
NT |
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*Presence of at least one joint or tendon. ACPA, anti-cyclic citrullinated peptide antibody; ACR, American College of Rheumatology; cPD, combined power Doppler; EULAR, European League Against Rheumatism; GLOESS, Global OMERACT-EULAR Synovitis Score; GS, grayscale; NPV, negative predictive value; PD, power Doppler; PPV, positive predictive value; RA, rheumatoid arthritis; RF, rheumatoid factor; NT, not tested. |
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Table 2. Diagnostic performance of combination of ultrasound and serologic findings |
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Hospital 1 |
Hospital 2 |
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|
Sensitivity |
Specificity |
PPV |
NPV |
Accuracy |
Sensitivity |
Specificity |
PPV |
NPV |
Accuracy |
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GS grade ≥2 and PD grade ≥1* |
84.3 |
91.1 |
81.9 |
92.4 |
88.9 |
78 |
86.6 |
67.6 |
91.6 |
84.3 |
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GS grade ≥2 or PD grade ≥1* |
92.9 |
82.9 |
72.2 |
96.0 |
86.1 |
88.1 |
71.3 |
52.5 |
94.4 |
75.8 |
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(1) PD grade ≥2* or (2) GS grade ≥2 + PD grade ≥1* |
88.6 |
91.1 |
82.7 |
94.3 |
90.3 |
80 |
86.6 |
68.1 |
92.2 |
84.8 |
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(1) PD grade ≥2* or (2) PD-positive tenosynovitis* |
88.6 |
93.2 |
86.1 |
94.4 |
91.7 |
81.4 |
78.7 |
57.8 |
92.1 |
79.4 |
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(1) PD grade ≥1* and (2) RF/ACPA-positive |
70 |
97.3 |
92.5 |
87.1 |
88.4 |
64.4 |
97 |
88.4 |
88.3 |
88.3 |
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(1) PD grade ≥2* and (2) RF/ACPA-positive |
62.9 |
100 |
100 |
84.9 |
88.0 |
50.8 |
99.4 |
96.8 |
84.9 |
86.5 |
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(1) PD grade ≥2*or (2) PD grade ≥1* and RF/ACPA-positive |
91.4 |
92.5 |
85.3 |
95.7 |
92.1 |
81.4 |
92.1 |
78.8 |
93.2 |
89.2 |
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(1) cPD grade ≥1* and (2) RF/ACPA-positive |
75.7 |
77.4 |
61.6 |
86.9 |
76.9 |
67.8 |
89.6 |
70.2 |
88.6 |
83.9 |
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(1) cPD grade ≥2* and (2) RF/ACPA-positive |
68.6 |
97.9 |
94.1 |
86.7 |
88.4 |
59.3 |
95.7 |
83.3 |
86.7 |
86.1 |
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(1) cPD grade ≥2*or (2) cPD grade ≥1* and RF/ACPA-positive |
97.1 |
67.8 |
59.1 |
98.0 |
77.3 |
91.5 |
73.8 |
55.7 |
96.0 |
78.5 |
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(1) cPD grade =3*or (2) cPD grade ≥2* and RF/ACPA-positive |
85.7 |
95.6 |
90.9 |
93.3 |
92.6 |
66.1 |
93.9 |
79.6 |
88.5 |
86.5 |
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*Presence at least one joint or tendon. ACPA, anti-cyclic citrullinated peptide antibody; cPD, combined power Doppler; GS, grayscale; NPV, negative predictive value; PD, power Doppler; PPV, positive predictive value; RA, rheumatoid arthritis; RF, rheumatoid factor. |
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To cite this abstract in AMA style:
Kawashiri S, Fujikawa K, Nishino A, Takatani A, Shimizu T, Umeda M, Fukui S, Igawa T, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Kawakami A. Combination of Ultrasound Power Doppler-Verified Synovitis and Seropositivity Accurately Identifies Patients with Early Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/combination-of-ultrasound-power-doppler-verified-synovitis-and-seropositivity-accurately-identifies-patients-with-early-rheumatoid-arthritis/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/combination-of-ultrasound-power-doppler-verified-synovitis-and-seropositivity-accurately-identifies-patients-with-early-rheumatoid-arthritis/