Objectives Recently ultrasonography (US) has been prevalent as a valid and objective modality of joint examination. As a result, accumulating findings of the association between joint US observations and physical examination of the joints or a composite measure of disease activity of rheumatoid arthritis (RA) have been available. Although usefulness of patient-reported outcome such as RAPID-3 has been reported, the association between patient-reported joint symptoms and US findings at each joint level has been rarely investigated. Therefore, we have examined the concordance between joint symptoms and US findings.
Methods Twenty-eight patients with RA (86% female, the mean age 66 years) were asked for the self-evaluation of joint symptoms including pain and considerable stiffness in (proximal) interphalangeal (PIP), metacarpophalangeal (MCP), wrist, elbow, shoulder, knee and ankle joints. Those joints were evaluated by physical examination for the presence of tenderness and/or swelling, and also by US for the presence of synovitis was defined as gray-scale (GS) imaging score ≥1 or a synovial power Doppler (PD) signal score ≥2.
Results The overall concordance rate between joint symptoms and US synovitis was low (κ coefficient =0.37; 95%CI 0.29-0.44), and it tended to be improved by joint examination by board-certified rheumatologists (κ =0.45; 95%CI 0.38-0.52). And the κ value between joint symptoms and US synovitis was 0.39 (95%CI 0.30-0.47) in small (PIP, MCP and wrist) joints, while it was 0.27 (95%CI 0.12-0.43) in large (shoulder, elbow, knee and ankle) joints. In addition, both joint symptom and US synovitis showed a trend toward better concordance with joint swelling than tenderness in small (κ =0.56 and 0.48 versus 0.50 and 0.33, respectively) and large joints (κ =0.36 and 0.44 versus 0.29 and 0.34, respectively).
Conclusions The concordance between patient-reported joint symptoms and US synovitis was poor, suggesting the importance of joint examinations by rheumatologists and by US, if available, including asymptomatic joints.
Disclosure of Interest None declared