Concordance of Patient‐Reported Joint Symptoms, Physician‐Examined Arthritic Signs, and Ultrasound‐Detected Synovitis in Rheumatoid Arthritis

Hirata, A.; Ogura, Takeshi; Hayashi, Norihide; Takenaka, Sayaka; Ito, Hideki; Mizushina, Kennosuke; Fujisawa, Yuki; Yamashita, Naoko; Nakahashi, Sumie; Imamura, M.; Kujime, Rie; Kameda, Hideto

doi:10.1002/acr.23006

Cited by 24 publications

(16 citation statements)

References 31 publications

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“…A cross-sectional study of 50 patients with RA found patient-reported symptoms (pain and joint stiffness) to have higher concordance with ultrasound findings than joint tenderness 40. In the present study, PRJP and tender joints were highly correlated at patient level but with only fair concordance at joint level, and both had low associations with swollen joints and ultrasound scores at patient as well as joint level.…”

Section: Discussioncontrasting

confidence: 45%

Swollen, but not tender joints, are independently associated with ultrasound synovitis: results from a longitudinal observational study of patients with established rheumatoid arthritis

et al. 2019

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ObjectivesJoint swelling and tenderness are considered a proxy for inflammation in patients with rheumatoid arthritis (RA). With ultrasound-detected inflammation as reference, our objectives were to explore on patient and joint level the associations between ultrasound synovitis and joint swelling, tenderness and patient-reported joint pain (PRJP).Methods209 patients with established RA were examined six times during 12 months with assessment of 32 joints in upper/lower extremities for joint swelling/tenderness and Grey scale (GS)/power Doppler (PD) synovitis. PRJP was assessed on a manikin. Correlations between different sum scores were at each examination calculated using Spearman’s rho (r), agreement at joint level was examined by Cohen’s kappa and logistic regression models were used to explore the associations between joint assessment and GS/PD scores.ResultsAt patient level, swollen joints were strongly correlated with GS/PD sum scores (r=0.64–0.88), while tender joints were primarily associated with PRJP (r=0.54–0.68). At joint level, GS/PD pathology had higher agreement with swelling (kappa 0.54–0.57) than tenderness (kappa 0.20–0.21) or PRJP (0.23–0.25). Higher percentages of joints were swollen according to increasing GS/PD scores, independently of joint tenderness. However, joints being tender, but not swollen, were not associated with GS/PD scores. Receiver operating curves showed swollen but not tender joints to be associated with GS/PD scores.ConclusionsSwollen joints were strongly associated with ultrasound detected synovitis at both patient and joint level, while this association was not found for tender joints. These results may question if tender joints reflect ongoing inflammation in established RA.

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Section: Discussioncontrasting

confidence: 45%

Swollen, but not tender joints, are independently associated with ultrasound synovitis: results from a longitudinal observational study of patients with established rheumatoid arthritis

et al. 2019

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“…This kind of problem can also be seen in the study of Hirata et al , also published in Arthritis Care & Research . The purpose of that article was not to evaluate the use of MTX, but to check the concordance between patient‐reported joint symptoms, physician‐examined arthritic signs, and ultrasound‐detected synovitis in RA.…”

mentioning

confidence: 63%

Methotrexate still works: comment on the articles by Rohr et al and Hirata et al

Moura

2018

Arthritis Care & Research

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“…These factors may contribute to overcalling synovitis by clinical examination/patient-report. Furthermore, it has been observed that the degree and direction of discrepancy between clinically and ultrasonography-detected synovitis may be related to joint region and size: superior concordance has been observed for larger joints (shoulder, elbow, knee and ankle) compared to smaller joints (PIP, MCP and wrist) (38).…”

Section: Discussionmentioning

confidence: 99%

“…To date, only few studies assessed the relationship between patients' self-assessment of joints and ultrasonography signs of inflammation (18,(37)(38)42). Direct comparisons across studies are challenging because different ultrasonography scoring systems are used in different sets of joints/ sites, and different measures of agreement are used.…”

Section: Discussionmentioning

confidence: 99%

Flares in rheumatoid arthritis: do patient-reported swollen and tender joints match clinical and ultrasonography findings?

et al. 2019

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Objectives To investigate how patient-reported flares in RA are related to clinical joint examination and inflammation detected by US. Methods Eighty RA patients with DAS28-CRP <3.2 and no swollen joints at baseline were followed for 1 year. In case of patient-reported hand flare with swollen and tender joints (SJ and TJ, respectively), patients underwent clinical examination for SJ/TJ and US of bilateral wrists, MCP and PIP 1st–5th, six extensor tendon compartments and wrist flexor tendons for synovitis/tenosynovitis. Percentage agreement and kappa were calculated between patient-reported SJ and TJ, clinical examination for SJ/TJ and US findings indicative of inflammation. With US as reference, sensitivity, specificity, positive/negative predictive value and accuracy of patient-reported and clinically examined joints were determined. Results Hand flare was reported by 36% (29/80) of patients. At time of flare, all clinical and ultrasonographic measures of disease activity deteriorated compared with baseline. Agreement between patient-reported SJ/TJ, clinically examined SJ/TJ and US was slight (kappa = 0.02–0.20). Patients and clinicians agreed in 79–93% of joints, more frequently on SJ than TJ. With US as reference, specificities were 86–100% and 88–100%, and sensitivities 12–34% and 4–32% for patient-reported SJ/TJ and clinically examined SJ/TJ, respectively. Conclusion Over 12 months of follow-up, hand flare was reported by every third RA patient. Self-reported flares were associated with increased disease activity as determined by clinical examination and US. Patient-reported joint assessment may aid in capturing flares between routine clinical visits.

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Concordance of Patient‐Reported Joint Symptoms, Physician‐Examined Arthritic Signs, and Ultrasound‐Detected Synovitis in Rheumatoid Arthritis

Abstract: Joint swelling showed the best concordance with ultrasonography, followed by patient-reported joint symptoms, and joint tenderness. Joint symptoms, rather than tenderness evaluation, may be a better clinical indicator of synovitis in RA patients.

Cited by 24 publications

References 31 publications

Swollen, but not tender joints, are independently associated with ultrasound synovitis: results from a longitudinal observational study of patients with established rheumatoid arthritis

Swollen, but not tender joints, are independently associated with ultrasound synovitis: results from a longitudinal observational study of patients with established rheumatoid arthritis

Methotrexate still works: comment on the articles by Rohr et al and Hirata et al

Flares in rheumatoid arthritis: do patient-reported swollen and tender joints match clinical and ultrasonography findings?

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