Relationship between clini-cally detected joint swelling and effusion diagnosed by ultrasonography in metatarsophalangeal and talocrural joints in patients with rheumatoid arthritis

R.K. Luukkainen¹, M. Saltyshev², J.M Koski³, H.S. Huhtala⁴

Departments of Rheumatology¹ and Physiatry², Satalinna Hospital, Harjavalta, Department of Internal Medicine³, Central Hospital of Mikkeli, Mikkeli, School of Public Health4, University of Tampere, Tampere, Finland

ABSTRACT
Objective
To assess the relationship between clinically detected swelling and effusion diagnosed by ultrasonography (US) in metatarsophalangeal (MTP) and talocrural (TC) joints in patients with rheumatoid arthritis (RA).

Methods
Thirty consecutive patients with RA were studied. Altogether 288 MTP joints and 60 TC joints were evaluated. The clinical investigations were carried out by one doctor and the US investigations by another and they were blinded to each others' results.

Results
The clinical examination and US gave similar results in 194 MTP joints, whereas they differed in the remaining 94 MTP joints, and correspondingly the results were similar in 34 TC joints and differed in 26 TC joints. The kappa coefficient between these investigations was 0.165 in MTP joints and 0.043 in TC joints, showing very poor agreement.

Conclusion
These preliminary results showed poor agreement between the clinical assessment of swelling and effusion detected by US in MTP and TC joints. Thus US may considerably improve the diagnosis of synovitis in patients with RA.

Key words
Clinical swelling, effusion, ultrasonography.

Please address correspondence and reprint requests to: Reijo Luukkainen, MD, 
Kreetalankatu 5C, 29200 Harjavalta, Finland. 
E-mail: reijo.luukkainen@fimnet.fi

Clin Exp Rheumatol 2003; 21: 632-634.
© Copyright Clinical and Experimental Rheumatology 2003.