Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis
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...
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | Arthritis Research & Therapy |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13075-017-1405-y |
| _version_ | 1819060128363577344 |
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| author | Myrthe van der Ven M. van der Veer-Meerkerk D. F. Ten Cate N. Rasappu M. R. Kok D. Csakvari J. M. W. Hazes A. H. Gerards J. J. Luime |
| author_facet | Myrthe van der Ven M. van der Veer-Meerkerk D. F. Ten Cate N. Rasappu M. R. Kok D. Csakvari J. M. W. Hazes A. H. Gerards J. J. Luime |
| author_sort | Myrthe van der Ven |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T14:22:04Z |
| format | Article |
| id | doaj.art-79413bc0590240cea1e26c284833e835 |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-12-21T14:22:04Z |
| publishDate | 2017-09-01 |
| publisher | BMC |
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| series | Arthritis Research & Therapy |
| spelling | doaj.art-79413bc0590240cea1e26c284833e8352022-12-21T19:00:45ZengBMCArthritis Research & Therapy1478-63622017-09-011911710.1186/s13075-017-1405-yAbsence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritisMyrthe van der Ven0M. van der Veer-Meerkerk1D. F. Ten Cate2N. Rasappu3M. R. Kok4D. Csakvari5J. M. W. Hazes6A. H. Gerards7J. J. Luime8Department of Rheumatology (Na609), Erasmus MC, University Medical Centre RotterdamDepartment of Rheumatology (Na609), Erasmus MC, University Medical Centre RotterdamDepartment of Rheumatology (Na609), Erasmus MC, University Medical Centre RotterdamDepartment of Rheumatology (Na609), Erasmus MC, University Medical Centre RotterdamDepartment of Rheumatology, Maasstad HospitalDepartment of Rheumatology (Na609), Erasmus MC, University Medical Centre RotterdamDepartment of Rheumatology (Na609), Erasmus MC, University Medical Centre RotterdamDepartment of Rheumatology, Vlietland HospitalDepartment of Rheumatology (Na609), Erasmus MC, University Medical Centre RotterdamAbstract 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.http://link.springer.com/article/10.1186/s13075-017-1405-yUltrasonographyPower DopplerArthralgiaInflammatory arthritis |
| spellingShingle | Myrthe van der Ven M. van der Veer-Meerkerk D. F. Ten Cate N. Rasappu M. R. Kok D. Csakvari J. M. W. Hazes A. H. Gerards J. J. Luime Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis Arthritis Research & Therapy Ultrasonography Power Doppler Arthralgia Inflammatory arthritis |
| title | Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis |
| title_full | Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis |
| title_fullStr | Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis |
| title_full_unstemmed | Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis |
| title_short | Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis |
| title_sort | absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis |
| topic | Ultrasonography Power Doppler Arthralgia Inflammatory arthritis |
| url | http://link.springer.com/article/10.1186/s13075-017-1405-y |
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