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

Abstract

IntroductionUltrasonography (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.Methods192 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.ResultsForty-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.ConclusionsUS 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.

Rheumatoid Arthritis Assessment with Ultrasonography

“…Van de Stadt studied 192 patients with polyarthralgia who had rheumatoid factor and / or CCP antibodies. Subclinical ultrasound anomaly of a joint was predictive of evolution toward authentic arthritis at joint level, but this wasn't true at patient level (Van de Stadt et al, 2010). Nevertheless, the topography of swollen joints and the other signs (like tenosynovitis and obviously erosions) may guide the diagnosis.…”

Review: Preclinical Rheumatoid Arthritis: Progress Toward Prevention

“…The value of ultrasound (US) as a biomarker in pre-RA has been assessed both in Dutch cohorts (59) and in UK cohorts (50) of seropositive patients with arthralgia. Van de Stadt et al (59) found that abnormalities detected on US imaging (joint effusion, synovitis on gray-scale and power Doppler) were predictive of arthritis development at the joint level but not at the patient level.…”

“…Van de Stadt et al (59) found that abnormalities detected on US imaging (joint effusion, synovitis on gray-scale and power Doppler) were predictive of arthritis development at the joint level but not at the patient level. The combination of gray-scale synovitis and power Doppler abnormalities was the strongest predictor of arthritis (OR 12.9 and PPV 35%).…”

Uloga ultrazvuka u dijagnostici ranog reumatoidnog artritisa

“…Pregled je uključio šest studija: u četiri studije ultrazvučni pregled je obuhvatio najmanje ručne zglobove i metakarpofalangealne zglobove, uz evaluaciju tetiva [12], proksimalnih interfalangealnih zglobova [15], metatarzofalangealnih zglobova, ramena, koljena i skočnog zgloba [16], distalnih interfalangealnih zglobova i lakta [17]. U petoj studiji uključeni su bolni zglobovi, pomoćni zglobovi iste regije i kontralateralni zglobovi [18]. Na početku šeste studije pregledani su samo bolni zglobovi, ali je kasnije došlo do promjene protokola i uključivanja bilateralnih metakarpofalangealnih i metatarzofalangealnih zglobova i koljena [19].…”