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. 2010;12(3):R98.
doi: 10.1186/ar3028. Epub 2010 May 20.

The value of ultrasonography in predicting arthritis in auto-antibody positive arthralgia patients: a prospective cohort study

Lotte A van de Stadt  1 , Wouter H Bos, Marlies Meursinge Reynders, Helen Wieringa, Franktien Turkstra, Conny J van der Laken, Dirkjan van Schaardenburg
Affiliations

The value of ultrasonography in predicting arthritis in auto-antibody positive arthralgia patients: a prospective cohort study

Lotte A van de Stadt et al. Arthritis Res Ther. 2010.

Abstract

Introduction: Ultrasonography (US) has better sensitivity than clinical evaluation for the detection of synovitis in early rheumatoid arthritis (RA). Patients presenting with arthralgia and a positive anti-citrullinated protein antibodies (ACPA) and/or Rheumatoid Factor (IgM-RF) status are at risk for developing RA. In the present study, US utility and predictive properties in arthralgia patients at risk for the development of arthritis were studied.

Methods: 192 arthralgia patients with ACPA and/or IgM-RF were included. Absence of clinical arthritis was confirmed by two physicians. US was performed by one of two trained radiologists of any painful joint, and of adjacent and contralateral joints. Joint effusion, synovitis and power Doppler (PD) signal in the synovial membrane of the joints and tenosynovitis adjacent to the joint were evaluated and classified on a 4-grade semi-quantitative scale. Grade 2-3 joint effusion, synovitis, tenosynovitis and grade 1-3 Power Doppler signal were classified as abnormal.

Results: Forty-five patients (23%) developed arthritis after a mean of 11 months. Inter-observer reliability for synovitis and PD was moderate (kappa 0.46, and 0.56, respectively) and for joint effusion low (kappa 0.23). The prevalence of tenosynovitis was too low to calculate representative kappa values. At joint level, a significant association was found between US abnormalities and arthritis development in that joint for joint effusion, synovitis and PD. At patient level, a trend was seen towards more arthritis development in patients who had US abnormalities for joint effusion, synovitis, PD and tenosynovitis.

Conclusions: US abnormalities were associated with arthritis development at joint level, although this association did not reach statistical significance at patient level. US could potentially be used as a diagnostic tool for subclinical arthritis in seropositive arthralgia patients. However, further research is necessary to improve test characteristics.

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Figures

Figure 1
Figure 1
Arthritis development of individual joints. During yearly follow-up visits, development of arthritis in any of 44 joints was independently confirmed by two investigators. The percentage of all arthritic joints in which arthritis developed in that particular joint is shown. Grey bars represent the right sided joints, black bars the left sided joints. AC, acromioclavicular; IP, interphalangeal; MCP, metacarpal phalangeal; MTP, metatarsophalangeal; PIP, proximal interphalangeal; SC, sternoclavicular.
Figure 2
Figure 2
Association of pain at baseline with arthritis development in joints of patients that developed arthritis. At baseline 53 joints per patient were scored for the presence of pain at physical examination. At the time of arthritis development 44 joints were scored for the presence of soft tissue swelling at physical examination. Depicted are the joints of patients that developed arthritis. Grey bars represent unaffected joints, black bars represent joints in which arthritis developed.
See this image and copyright information in PMC

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