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A diagnostic algorithm for persistence of very early inflammatory arthritis: the utility of power Doppler ultrasound when added to conventional assessment tools
  1. J E Freeston,
  2. R J Wakefield,
  3. P G Conaghan,
  4. E M A Hensor,
  5. S P Stewart,
  6. P Emery
  1. Academic Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK
  1. Correspondence to Dr P Emery, Academic Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; p.emery{at}leeds.ac.uk

Abstract

Objectives: The aim of this study was to assess the value of power Doppler ultrasound (PDUS) in combination with routine management in a cohort of patients with very early inflammatory arthritis (IA).

Methods: 50 patients with ⩽12 weeks of inflammatory symptoms with or without signs had clinical, laboratory and imaging assessments. Diagnosis was recorded at 12 months. Assuming a 15% pre-test probability of IA, post-test probabilities for various assessments were calculated and used to develop a diagnostic algorithm.

Results: All patients positive for rheumatoid factor (RF) and/or cyclic citrullinated peptide (CCP) developed persistent IA, so the added value of PDUS was assessed in the seronegative (RF and CCP negative) group. The probability of IA in a seronegative patient was 6%. The addition of clinical and radiographic features raised the probability of IA to 30% and, with certain ultrasound features, this rose to 94%.

Conclusions: In seronegative patients with early IA, combining PDUS with routine assessment can have a major impact on the certainty of diagnosis.

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Footnotes

  • Funding JEF was supported by a Centocor Research Fellowship.

  • Competing interests None.

  • Patient consent All patients gave their informed consent.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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