Background Ultrasonography is widely used in Rheumatology practice to detect articular and periarticular lesions. To date, elbow clinical findings have not been compared with ultrasonography (US) and conventional radiography (RX) in patients with different inflammatory arthropathies (IA).
Objectives To study the associations and agreement between clinical, US and RX elbow abnormalities in patients with IA.
Methods 243 elbows of 122 consecutive patients ( 86 women/37 men, 54.4 ±13.2 years old ) with rheumatoid arthritis (62), spondyloathritis (20) psoriatic arthritis (19) and other IA (21) from a University Hospital Rheumatology Clinic gave informed consent to enroll in the study. The clinical rheumatologists recorded local elbow pain, tenderness, swelling, motion loss, specific resisted maneuvers and established a clinical based diagnosis of elbow arthritis, olecranon bursitis, cubital bursitis, common extensor entesopathy, common flexor entesopathy and/or triceps entesopathy. A systematic EULAR elbow B-mode and Doppler ultrasound (US) examination (Logic 9, probe ML12 General Electric, Wauwatosa, Wisconsin,) was performed by one expert rheumatologist-sonographer (JU) blinded to patients diagnosis and clinical examination. OMERACT definitions for synovitis and entesopathy were used (J Rheumatol 2005;32:2485-7). Anterior and lateral elbow radiographs (RX) were read by one rheumatologist (RM) blinded to clinical information. Descriptive statistics, Fisher´s exact test and kappa indexes were computed to study association and concordance between clinical, US and RX findings.
Results In 176 painless elbows, clinical joint exam (CJE) was normal in 170 (96%) whereby pathology was found in 92 (52%) US exams and 37 (22%) RX. In 65 elbows with local pain, CJE was pathologic in 57 (86%) however, normal US and RX was recorded in 12 (19 %) and 27 (44.3%) elbows respectively. Clinical, US and RX findings were associated with pain (p < 0.0005). Despite that agreement was strong with clinical findings(ƙ = 0.8) it was poor, though significant with US (ƙ = 0.16) and RX (ƙ =0.24) findings. US synovitis was found in 63 elbows and clinically suspected in 21 (p<0.0005, ƙ= 0.5). US extensor tendon entesopathy was detected in 38 elbows and clinically suspected in 14 (p< 0.0005, ƙ= 0.3). US entesophyts and intra-articular erosions were detected 3 times more with US than RX. Common flexor entesopathy, triceps entesopathy and olecranon bursitis were rare. Cubital bursitis was not found.
Conclusions Strong associations were found between clinical, US and RX findings although agreement was poor. US detects more elbow articular and periarticular pathology than joint examination and radiographs
Disclosure of Interest None Declared