Session Information
Date: Sunday, November 8, 2015
Title: Imaging of Rheumatic Diseases Poster I: Ultrasound, Optical Imaging and Capillaroscopy
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Ultrasonography (US) is increasingly
accepted as an important tool in diagnosis and management of rheumatoid
arthritis (RA). However, it is not
well known to what extent US adds information to
clinical examination at the individual joint level. Our objective was to assess
concordance between clinical joint examination and US in detecting synovitis at
the individual joint level in a cohort of early RA patients.
Methods: 228 patients with early RA who fulfilled the
2010 ACR/EULAR classification criteria were recruited at 11 Rheumatology centers between 2010 and 2013. Patients were required to
have symptom duration <2 years (from onset of joint swelling) and to be DMARD
na•ve with indication for DMARD treatment. 44 joints were assessed for swelling
by a rheumatologist or trained research nurse. US examinations were performed
by experienced and well-calibrated sonographers,
using a validated gray-scale (GS) and power Doppler (PD) semi-quantitative
scoring system with scores 0-3 for GS and PD in each of the following 36
joints: MCP 2-5, radio-carpal (RCJ), distal radio-ulnar (DRUJ), inter-carpal
(ICJ), PIP 2-3, elbow, knee, talo-crural and MTP 1-5
bilaterally. We defined US synovitis (US+) as GS ³2 and/or PD ³1. For the wrist the US comparison
with clinical joint swelling included one or
several of the RCJ, DRUJ and ICJ. Joints were assessed bilaterally
and analysed on an aggregated level. Kappa values between clinical joint
swelling and US synovitis were calculated for all joints. We specifically
assessed the proportion of joints with US synovitis that were not clinically
swollen, and vice versa.
Results: The mean age (SD) of the 228 patients was 51.1
(13.8) years, mean (SD) disease duration 7.1 (5.4)
months and 62.3% were female. Mean (SD) DAS was 3.47 (1.13) the median (25, 75
percentiles) number of swollen joints was 9 (4, 14), and
the median (25, 75 percentiles) number of
joints with US synovitis
was 7 (3,11). A total of 8208 joints were examined
by US. Agreement between US and clinical examination was best in the elbow,
wrist and knee (kappa 0.68, 0.53, 0.51, respectively). The proportion of joints
with US synovitis that were not clinically swollen ranged from 16% (PIP2) to
76% (MTP1). The six joints with the largest and smallest discrepancies are
presented in the table. Similarly, a significant proportion of clinically
swollen joints had no US synovitis, ranging from 23% (wrist and elbow) to 70%
(ankle).
|
Table: Comparison of US synovitis and clinical joint swelling in selected joints*
|
||||||
|
Joint
|
Swollen
|
Not Swollen
|
Kappa
|
Proportion of joints with US synovitis and no clinical swelling
|
Proportion of swollen joints without US synovitis
|
|
|
MTP1
|
US+
|
35 |
112 |
0.18 |
76% |
43% |
|
US-
|
26 |
282 |
||||
|
MTP5
|
US+
|
30 |
66 |
0.30 |
69% |
43% |
|
US-
|
23 |
337 |
||||
|
MCP4
|
US+
|
28 |
53 |
0.33 |
65% |
46% |
|
US-
|
24 |
351 |
||||
|
Wrist
|
US+
|
139 |
62 |
0.53 |
31% |
23% |
|
US-
|
42 |
213 |
||||
|
PIP3
|
US+
|
90 |
21 |
0.42 |
19% |
53% |
|
US-
|
100 |
245 |
||||
|
PIP2
|
US+
|
100 |
19 |
0.45 |
16% |
50% |
|
US-
|
100 |
237 |
||||
|
*Joints are sorted by the proportion of joints with US synovitis and no clinical swelling.
|
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Conclusion: In this study of patients with early RA we
found the level of agreement between US and clinical examination to be somewhat
higher in medium to large joints compared to small joints. However, substantial
discrepancies between clinical joint swelling and US pathology were found for
most joints, and these findings support that US provides additional information
compared to clinical examination in most joint areas.
To cite this abstract in AMA style:
Nordberg LB, Lie E, Lillegraven S, Aga AB, Olsen IC, Hammer HB, Uhlig T, van der Heijde D, Kvien TK, Haavardsholm EA. Ultrasonography Versus Clinical Examination in Early DMARD-Naïve Rheumatoid Arthritis – a Comparative Study of Synovitis on the Individual Joint Level [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/ultrasonography-versus-clinical-examination-in-early-dmard-naive-rheumatoid-arthritis-a-comparative-study-of-synovitis-on-the-individual-joint-level/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonography-versus-clinical-examination-in-early-dmard-naive-rheumatoid-arthritis-a-comparative-study-of-synovitis-on-the-individual-joint-level/