The relationship of patient-reported joints with active synovitis detected by power Doppler ultrasonography in rheumatoid arthritis

CER5948
2013 Vol.31, N°4
PI 0490, PF 0497
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PMID: 23484455 [PubMed]

Received: 03/09/2012
Accepted : 03/12/2012
In Press: 13/03/2013
Published: 29/07/2013

Abstract

OBJECTIVES:
This paper aims to evaluate the relationship of patient-reported tender and swollen joints with active inflammation as detected by power Doppler (PDUS) and whether this relationship is affected by significant joint damage.
METHODS:
Fifty rheumatoid arthritis patients self-assessed 28 tender and swollen joints and were followed by PDUS assessment. Relationship of tender and swollen joints with active synovitis (PDUS `gold standard`) was assessed at the joint level by: a) percentage agreement at each PDUS semiquantitative grade (grade 1 to 3), b) positive likelihood ratio (LR) of agreement with PDUS, and c) LR of agreement with PDUS according to radiographic damage (significant erosive disease vs. non-erosive disease). Correlation of tender and swollen joint counts with disease activity markers was analysed by Spearman`s. Sensitivity analyses examined the influence of disease activity or global pain on level of agreement at the joint level.
RESULTS:
Of joints with significant active inflammation (e.g. grade 3 PDUS), patients identified 75% as tender and 63% as swollen. Swollen joints showed strong association at the joint level with active synovitis when there was no significant radiographic damage (LR 2.54, 95%CI 1.93–3.34), but with no significant radiographic damage (LR 1.32, 95%CI 0.75-2.32). Swollen joint counts were statistically correlated with PDUS-DAS28 and CRP, but not PDUS score. Sensitivity analysis showed better agreement of tender and swollen joints with active synovitis when DAS28 was ≤ 3.2 and when patient global pain was <50mm on visual analogue scale.
CONCLUSIONS:
The relationship between patient-reported joints and active synovitis is stronger in the setting of low disease activity without erosive disease, affected also by degree of reported global pain. Further longitudinal studies of patient-reported joints are needed.