Session Type: Abstract Submissions (ACR)
To establish the importance of joint examination by ultrasound (US) in daily clinical practice of patients with rheumatoid arthritis (RA), we compared the US findings with the joint examination findings sorted by the presence of tenderness and/or swelling in the hand (proximal) interphalangeal (IP/PIP), metacarpophalangeal (MCP) and wrist joints.
A total of 208 RA patients (158 female, the mean age of 66 years) completed clinical, laboratory and US assessments between October 2011 and December 2013. Clinical joint assessments determined the presence of tenderness alone (T) or swelling alone (S), both (TS) or none (N) of them. US synovitis was defined as gray-scale (GS) imaging score ≥ 1 (graded 0-3) or a synovial power Doppler (PD) signal score ≥ 2 (graded 0-3).
Among total joints assessed, US synovitis was observed in 146 of 178 TS joints (82%), 50 of 128 T joints (28%), 130 of 201 S joints, and 309 of 3710 N joints. Therefore, joint swelling is more closely associated with US synovitis than joint tenderness. Next, even among TS joints, US synovitis was observed only in 50% (23/46) of IP/PIP joints, which was significantly less than 95% (55/58) and 92% (68/74) for the wrist and MCP joints, respectively (p<0.01). Among N joints, conversely, US synovitis was observed in 32% (92/286) of the wrist joints, which was greater than 9%(56/624) for the MCP joints and 9% (52/1898) of IP/PIP joints (p<0.0001).
Based on the US findings, physical joint examination of the IP/PIP and the wrist joints tends to overestimate and underestimate synovitis, respectively. Thus, clinical importance of US examination in daily clinical practice may differ among joint sites, probably due to the structural complexity in the wrists and the co-existing osteoarthritis in IP/PIP joints.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-comparison-between-physical-and-ultrasound-joint-examination-for-the-hand-joints-in-patients-with-rheumatoid-arthritis/