FRI0598 The agreements between clinical signs and ultrasound-determined joint inflammation in patients with rheumatoid arthritis
Authors: X. Sun, X. Deng, W. Xie, Y. Geng, L. Ji, X. Zhang, Z. Zhang
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The identification of synovial inflammation in rheumatoid arthritis (RA) patients mainly depends on the presence of tenderness and/or swelling joints by physical examination, however not entirely reliable. Ultrasound, especially the synovial hyperplasia evaluated by grey scale (GS) and synovitis by power Doppler (PD), is more sensitive in reflecting joint inflammation, but their clinical significance has not been fully understood<sup>[1]</sup>. <h3>Objectives</h3> To investigate the agreement between clinical-detected signs and US features of joint inflammation in wrists and hands, and further determine the grades of GS synovial hyperplasia and PD synovitis which correspond to presence of tenderness or swelling in an individual joint in RA patients. <h3>Methods</h3> Twenty-two joints, including bilateral wrists, proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints, were respectively evaluated by clinical and ultrasound examination by different rheumatologists in 258 RA patients. Ultrasound-determined joint inflammation, including synovitis, tenosynovitis/peritendinitis, were detected, by using semi-quantitative scoring systems (0–3) for GS synovial hyperplasia and PD synovitis, and qualitative scoring systems (0/1) for tenosynovitis/peritendinitis. <h3>Results</h3> The median age of 258 enrolled patients were 51.4 years with 82.9% females. Their median disease duration was 55 months, and median disease activity score based on 28 joint count were 4.6. In a total of 5676 joints assessed, 968 joints (17.1%) were swollen and 1296 joints (22.8%) were tender, while on ultrasonography GS synovial hyperplasia was present in 801 (14.1%) joints, PD synovitis in 476 (8.4%) joints and tenosynovitis/peritendinitis in 108 (1.9%) joints. The general agreement between clinical signs and ultrasound-determined joint inflammation in all joints was fair (κ=0.365, p&lt;0.01). In wrists, joint tenderness showed higher κ coefficient (κ=0.329, p&lt;0.01) with ultrasound-determined joint inflammation than swelling (κ=0.263, p&lt;0.01), while on the contrary, swelling showed higher κ coefficient (κ=0.156–0.536, p&lt;0.01) with ultrasound-determined joint inflammation than tenderness (κ=0.061–0.355, p&lt;0.05) in MCP and PIP joints. Both synovial hyperplasia and synovitis detected by ultrasound had consistently higher agreement with tenderness/swelling than tenosynovitis/peritendinitis. Joint tenderness and swelling had the highest κ coefficient with GS ≥1 synovial hyperplasia in most MCP and PIP joints, while with GS ≥2 synovial hyperplasia in wrists. For all 22 joints, PD ≥1 synovitis had the highest κ coefficient with clinical tenderness and swelling. <h3>Conclusions</h3> Synovitis had better agreement with clinical signs than tenosynovitis/peritendinitis. Joint swelling showed better agreement with these ultrasonographic changes than tenderness for MCP and PIP joints, while the opposite for wrists. The minimal requirements of synovial hyperplasia/synovitis which correspond to clinical signs are GS ≥1 for MCP and PIP joints, GS ≥2 for wrists, but PD ≥1 for any joint. <h3>Reference</h3> [1] Yamada Y, Ogasawara M, Gorai M, et al. The synovial grade corresponding to clinically involved joints and a feasible ultrasound-adjusted simple disease activity index for monitoring rheumatoid arthritis. Mod Rheumatol2016;26:844–849. <h3>Acknowledgements</h3> We'd like to thank all those who contributed to our study. <h3>Disclosure of Interest</h3> None declared