Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Sep 15;19(1):202.
doi: 10.1186/s13075-017-1405-y.

Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis

Myrthe van der Ven  1 , M van der Veer-Meerkerk  2   3 , D F Ten Cate  2 , N Rasappu  2 , M R Kok  4 , D Csakvari  2 , J M W Hazes  2 , A H Gerards  5 , J J Luime  2
Affiliations
Multicenter Study

Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis

Myrthe van der Ven et al. Arthritis Res Ther. .

Abstract

Background: To decrease the burden of disease of rheumatoid arthritis (RA), patients at risk for RA need to be identified as early as possible, preferably when no clinically apparent synovitis can be detected. Up to now, it has been fairly difficult to identify those patients with arthralgia who develop inflammatory arthritis (IA), but recent studies using ultrasound (US) suggest that earlier detection is possible. We aimed to identify patients with arthralgia developing IA within 1 year using US to detect subclinical synovitis at first consultation.

Methods: In a multi-centre cohort study, we followed patients with arthralgia with at least two painful joints of the hands, feet or shoulders without clinical synovitis over 1 year. Symptom duration was < 1 year, and symptoms were not explained by other conditions. At baseline and at 6 and 12 months, data were collected for physical examinations, laboratory values and diagnoses. At baseline, we examined 26 joints ultrasonographically (bilateral metacarpophalangeal joints 2-5, proximal interphalangeal joints 2-5, wrist and metatarsophalangeal joints 2-5). Scoring was done semi-quantitatively on greyscale (GS; 0-3) and power Doppler (PD; 0-3) images. US synovitis was defined as GS ≥ 2 and/or PD ≥ 1. IA was defined as clinical soft tissue swelling. Sensitivity and specificity were used to assess the diagnostic value of US for the development of IA. Univariate logistic regression was used to analyse the association between independent variables and the incidence of IA. For multivariate logistic regression, the strongest variables (p < 0.157) were selected. Missing values for independent variables were imputed.

Results: A total of 196 patients were included, and 159 completed 12 months of follow-up. Thirty-one (16%) patients developed IA, of whom 59% showed US synovitis at baseline. The sensitivity and specificity of US synovitis were 59% and 68%, respectively. If no joints were positive on US, negative predictive value was 89%. In the multivariate logistic regression, age (OR 1.1), the presence of morning stiffness for > 30 minutes (OR 3.3) and PD signal (OR 3.4) were associated with incident IA.

Conclusions: The presence of PD signal, morning stiffness for > 30 minutes and age at baseline were independently associated with the development of IA. Regarding the value of US in the diagnostic workup of patients with early arthralgia at risk for IA, US did perform well in ruling out IA in patients who did not have US synovitis.

Keywords: Arthralgia; Inflammatory arthritis; Power Doppler; Ultrasonography.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was obtained from the participants according to the Declaration of Helsinki. The study was approved by the medical ethics committee of Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands (MEC-2010-353) and was assessed for feasibility by the local ethical bodies of Maasstad Hospital and Vlietland Hospital.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart showing the distribution of patients during follow-up
See this image and copyright information in PMC

References

    1. Finckh A, Liang MH, van Herckenrode CM, de Pablo P. Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: a meta-analysis. Arthritis Rheum. 2006;55:864–72. doi: 10.1002/art.22353. - DOI - PubMed
    1. Verstappen SM, McCoy MJ, Roberts C, Dale NE, Hassell AB, Symmons DP, et al. Beneficial effects of a 3-week course of intramuscular glucocorticoid injections in patients with very early inflammatory polyarthritis: results of the STIVEA trial. Ann Rheum Dis. 2010;69:503–9. doi: 10.1136/ard.2009.119149. - DOI - PubMed
    1. Hazes JM, Luime JJ. The epidemiology of early inflammatory arthritis. Nat Rev Rheumatol. 2011;7:381–90. doi: 10.1038/nrrheum.2011.78. - DOI - PubMed
    1. van Steenbergen HW, Huizinga TW, van der Helm-van Mil AH. The preclinical phase of rheumatoid arthritis: what is acknowledged and what needs to be assessed? Arthritis Rheum. 2013;65:2219–32. doi: 10.1002/art.38013. - DOI - PubMed
    1. Wakefield RJ, Freeston JE, O’Connor P, Reay N, Budgen A, Hensor EM, et al. The optimal assessment of the rheumatoid arthritis hindfoot: a comparative study of clinical examination, ultrasound and high field MRI. Ann Rheum Dis. 2008;67:1678–82. doi: 10.1136/ard.2007.079947. - DOI - PubMed

Publication types