Concordance between patient reported, physician-examined and ultrasound-detected rheumatoid arthritis symptoms
A traditional method of monitoring the joint disease in rheumatoid arthritis (RA) is X-rays whereby images are produced by exposing photographic film. Modern treatment for RA is frequently directed at early disease. Several radiographic imaging modalities have been explored including MRI (Magnetic Resonance Imaging) and ultrasonography. Among them, ultrasonography is an attractive method of imaging because of its low cost.
Ultrasonography has been prevalently used as a valid and objective modality for joint examination of RA. The study was conducted to examine and compare the concordance between ultrasound, clinical and patient-reported assessment of joint synovitis in RA.
In the study, 51 patients with RA were selected who completed self-evaluation of joint symptoms including pain and considerable stiffness in the proximal interphalangeal, metacarpophalangeal, wrist, elbow, shoulder, knee and ankle joints. These joints were also examined by the physician to assess the presence of tenderness or swelling. However, the presence of imaging synovitis was assessed by ultrasonography.
Results were evaluated after study completion. Total of 1492 evaluated joints, symptoms like pain and stiffness, tenderness and swelling were noted in 288, 182 and 220 joints respectively, while ultrasound indicated synovitis in 317 joints. The overall concordance rate with ultrasound findings was lowest for joint tenderness, followed by concordance with symptoms and swelling, irrespective of the evaluated joint, but excepting elbow. Moreover, percentages of inflamed joints which were detected only on the basis of symptoms, tenderness or swelling were 18.6%, 2.2% and 8.5% respectively of all joints with synovitis signs or ultrasonography.
It was concluded that joint swelling showed the best concordance with ultrasonography, followed by patient reported joint symptoms and joint tenderness. Joint symptoms, rather than tenderness evaluation may provide a better clinical indicator of synovitis in RA patients.