Significance of clinical evaluation of the metacarpophalangeal joint in relation to synovial/bone pathology in rheumatoid and psoriatic arthritis detected by magnetic resonance imaging

The Journal of Rheumatology
Millicent A StoneEdward C Keystone

Abstract

Rheumatologists base many clinical decisions regarding the management of inflammatory joint diseases on joint counts performed at clinic. We investigated the reliability and accuracy of physically examining the metacarpophalangeal (MCP) joints to detect inflammatory synovitis using magnetic resonance imaging (MRI) as the gold standard. MCP joints 2 to 5 in both hands of 5 patients with rheumatoid arthritis (RA) and 5 with psoriatic arthritis (PsA) were assessed by 5 independent examiners for joint-line swelling (visually and by palpation); joint-line tenderness by palpation (tender joint count, TJC) and stress pain; and by MRI (1.5 Tesla superconducting magnet). Interrater reliability was assessed using kappa statistics, and agreement between examination and corresponding MRI assessment was assessed by Fisher's exact tests (p < 0.05 considered statistically significant). Interrater agreement was highest for visual assessment of swelling (kappa = 0.55-0.63), slight-fair for assessment of swelling by palpation (kappa = 0.19-0.41), and moderate (kappa = 0.41-0.58) for assessment of joint tenderness. In patients with RA, TJC, stress pain, and visual swelling assessment were strongly associated with MRI evaluation of synovitis. Visu...Continue Reading

References

Jan 1, 1988·Annual Review of Public Health·S J KuritzG G Koch
Oct 23, 2001·Arthritis and Rheumatism·M BoersUNKNOWN COBRA Trial Group. Combinatietherapie Bij Reumatoide Artritis
Aug 19, 2006·Annals of the Rheumatic Diseases·Simon J BondDafna D Gladman

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Citations

Jun 28, 2011·Rheumatology·Esperanza NaredoUNKNOWN Ultrasound School of the Spanish Society of Rheumatology and Spanish ECO-APs Group
Apr 27, 2013·Annals of the Rheumatic Diseases·Jacqueline E ParamartaDominique Baeten
Jun 7, 2013·Annals of the Rheumatic Diseases·Rusmir HusicChristian Dejaco
Feb 18, 2016·BMC Musculoskeletal Disorders·João RoviscoMarwin Gutierrez
May 28, 2014·International Journal of Rheumatic Diseases·Hua XiaoJinwei Chen
Aug 5, 2016·Expert Review of Clinical Immunology·Ashish J MathewPhilip G Conaghan
Feb 6, 2017·The Journal of Rheumatology·Lihi EderDafna D Gladman
Aug 3, 2021·The Journal of Rheumatology·Dafna D GladmanRichard J Cook

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