063 Real-life benefits of ultrasound evaluation of hand and foot synovitis and lack of correlation with DAS-28 in rheumatoid arthritis

Ciurtin, Coziana; Jones, Alexis; Brown, Geraint; Sin, Fang-En; Reine, Charles; Manson, Jessica; Giles, Ian

doi:10.1093/rheumatology/kez106.062

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“…This strategy relies on accurate monitoring of disease activity using composite DASs, including the clinical disease activity index (CDAI), the simplified disease activity index (SDAI) and most the most commonly used, DAS-28. Nonetheless, there are various criticisms of the DAS-28, including the subjective nature of clinical assessments of joint tenderness and swelling, the low specificity of the global visual analog scale [ 6 ] and its inability to detect foot arthritis [ 7 ]. Previous studies reveal that as many as one-third of patients classified in DAS-28 remission present with clinical and/or US-detected manifestations of foot synovitis, which might elevate their risk of radiographic joint degeneration and poor functional outcomes [ 5 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, there are various criticisms of the DAS-28, including the subjective nature of clinical assessments of joint tenderness and swelling, the low specificity of the global visual analog scale [ 6 ] and its inability to detect foot arthritis [ 7 ]. Previous studies reveal that as many as one-third of patients classified in DAS-28 remission present with clinical and/or US-detected manifestations of foot synovitis, which might elevate their risk of radiographic joint degeneration and poor functional outcomes [ 5 , 7 ]. In addition, although some patients might achieve clinical remission according to the DAS-28, they can still develop foot joint damage in the form of erosions, indicating that management driven by DAS-28 might not address foot disease adequately.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the construct validity of musculoskeletal ultrasound and the rheumatoid arthritis foot disease activity index (RADAI-F5) for managing rheumatoid foot disease

Hoque

Steultjens

Dickson

et al. 2023

Rheumatology Advances in Practice

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Objectives The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is a valid, reliable, and clinically feasible patient-reported outcome measure (PROM) for the measurement of rheumatoid arthritis (RA) foot disease activity. Further validation of the RADAI-F5 against musculoskeletal ultrasonography (MSUS) for foot disease activity are necessary prior to clinical implementation. This study aimed to examine the construct validity of the RADAI-F5 in relation to MSUS and clinical examination. Method Participants with RA completed the RADAI-F5. MSUS was employed to evaluate disease activity (synovial hypertrophy/synovitis/tenosynovitis/bursitis) and joint damage (erosion) utilising grayscale (GS) and power Doppler (PD) at 16 regions in each foot, including joints and soft tissues. These same regions were examined clinically for swelling and tenderness. The construct validity of the RADAI-F5 was assessed using correlation coefficients and a priori-specified hypotheses for the strength of associations. Results Of 60 participants, 48 were female, with a mean [standard deviation, ± SD] age of 62.6 ± 9.96 and median disease duration of 15.49 (interquartile range 6–20.5) years. Theoretically consistent associations confirming construct validity [95% CI] were observed between the RADAI-F5 and MSUS GS (0.76 [0.57-0.82]; strong), MSUS PD (0.55 [0.35-0.71]; moderate), MSUS-detected erosions (0.41 [0.18-0.61]; moderate), clinical tenderness (0.52 [0.31-0.68]; moderate), and clinical swelling (0.36 [0.13-0.55]; weak). Conclusion Moderate-to-strong correlations between RADAI-F5 and MSUS demonstrate this instrument's good measurement properties. With greater confidence in the utility of the RADAI-F5, clinical use of this novel instrument as an adjunct to the DAS-28 could help identify RA patients at risk for poor functional and radiological outcomes. Lay summary What does this mean for patients? Rheumatoid arthritis (RA) is a condition that commonly affects the feet. It is important to have a reliable way to measure the activity of RA in the feet. One such measure is called the Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5), which is a five item questionnaire completed by patients. However, the RADAI-F5 still needs to be validated against other methods of assessing foot disease activity, such as musculoskeletal ultrasonography (MSUS) and clinical examination. In this study, 60 participants with RA were enrolled. Participants completed the RADAI-F5 questionnaire. Thereafter, MSUS was used to evaluate disease activity and joint damage in the participants' feet. Clinical examinations to assess swelling and tenderness were also conducted at this appointment. The results showed that there were strong-to-moderate consistent associations between the RADAI-F5 scores and MSUS grayscale images, MSUS Power Doppler and the presence of joint damage. The RADAI-F5 scores also correlated moderately with clinical tenderness and weakly with clinical swelling. These findings suggest that the RADAI-F5 is a reliable tool for measuring foot disease activity in RA patients. The tools implementation in clinical practice may help better identify RA patients who are at risk for poor outcomes and may require more targeted treatment.

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