FRI0073 SWELLING OR TENDERNESS, WHICH ONE CORRESPONDS BETTER WITH ULTRASOUND-DETECTED SYNOVITIS?
Authors: Xiaoying Sun, Xuerong Deng, Wenhui Xie, Yu Wang, Zhuoli Zhang
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Ultrasound (US) is a sensitive method for detecting joint inflammation in patients with rheumatoid arthritis (RA). The relationship between tender or swollen joints and ultrasound-detected synovitis has not been well explored in patients with RA. <h3>Objectives</h3> The purpose of the present study was to compare the correlation between ultrasound-detected synovitis and joint tenderness or swelling at the wrists and hands in RA patients. <h3>Methods</h3> Twenty-two joints, including bilateral wrists, proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints, were respectively evaluated by physical examination (PE) and ultrasound scan in 258 RA patients. All patients had at least 1 tender or swollen joint out of 22 joints. Synovitis was detected by using semi-quantitative scoring systems (0-3) for grey scale(GS) and power Doppler(PD). Positive synovitis was defined as GS≥2 and/or PD≥1. All correlations among US variables and clinical variables were assessed using Spearman's rank correlation test. Cohen's kappa (κ) between clinical and sonographic findings was calculated. <h3>Results</h3> Their median age was 51.2 years, median disease duration was 57 months, with 83.33% females. The mean (SD) Disease Activity Score based on 28 joints (DAS28)-ESR and DS28-CRP were 4.47±1.62 and 3.99±1.51, respectively. In a total of 5676 joints assessed, 968 swollen joints (17.05%) and 1296 tender joints (22.83%) were found, while on ultrasonography GS synovial hyperplasia was present in 801 (14.11%) joints, positive PD in 476 (8.38%) joints. There were more tender joints without swelling (n=574) than those swollen joints without tenderness (n=246). In all joints, higher κ coefficient was observed in joint swelling (κ=0.367, p&lt;0.01) with ultrasound-detected synovitis compared with tenderness (κ=0.281, p&lt;0.01).Similarly, swollen joint counts of 22 joints showed higher Spearman's correlation coefficient with either total GS scores (r=0.499, p&lt;0.01) or total PD scores of 22 joints (r=0.430, p&lt;0.01) than tender joint counts of 22 joints (r=0.354/0.308, p&lt;0.01). GS and PD synovitis were more frequently detected in swollen joints without tenderness compared with tender joints without swelling. This discrepancy tend to be more significant in MCP2, MCP3, and MCP4 joints (p&lt;0.05). <h3>Conclusion</h3> In RA patients with at least 1 tender or swollen joint of wrists and hands, a higher frequency of joint tenderness was observed than swelling. However, swelling had better agreement with ultrasound detected synovitis compared with tenderness. Joint swelling is more associated with ultrasound-detected synovitis than tenderness. Without swelling, joint tenderness tends to be less associated with ultrasound-detected synovitis. <h3>Reference</h3> [1] Tan YK, Moorakonda RB, Allen JC Jr, Chew LC, Thumboo J. Back to the basics: Understanding joint swelling and tenderness at the wrist in rheumatoid arthritis through the use of ultrasonography. Int J Rheum Dis. 2018 Oct 21. <h3>Acknowledgement</h3> The authors thank all the colleagues in our department for kind cooperation in this project and the patients for participating in this study. <h3>Disclosure of Interests</h3> None declared