Abstract
The objective of this study is to assess the reliability of clinical examination in patients with erosive osteoarthritis (EOA). Eighteen patients with EOA underwent clinical examination for joint tenderness, bony swelling, and inflammation by two independent, blinded assessors. All patients were also examined by ultrasound (US) by an independent radiologist. The inter-observer agreement was moderate for bony swelling and joint tenderness and fair for joint inflammation (κ = 0.513, 0.448, and 0.402, respectively). US detected significantly more inflamed joints than clinical examination. The sensitivity and specificity of clinical examination for joint inflammation were 0.12 and 0.95, respectively. Clinical joint counts for bony swelling, tenderness, and inflammation all correlated with functional status, assessed by the functional index for hand osteoarthritis (FIHOA), whereas US joint counts for joint inflammation did not correlate with the FIHOA. No correlation was found between any clinical or US joint count and visual analog scale for pain. US detects more joints with inflammation than clinical examination in patients with EOA. US can supplement the clinical examination of patients with EOA, as US-detected subclinical joint inflammation might accelerate joint damage and thus functional impairment.
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Punzi L, Ramonda R, Sfriso P (2004) Erosive osteoarthritis. Best Pract Res Clin Rheumatol 18:739–758
Salaffi F, Filippucci E, Carotti M, Nerado E, Meenagh G, Ciapetti A, Savic V, Grassi W (2008) Inter-observer agreement of standard joint counts in early rheumatoid arthritis: a comparison with grey scale ultrasonography—a preliminary study. Rheumatology (Oxford) 47:54–58
Scott DL, Antoni C, Choy EH, Van Riel PC (2003) Joint counts in routine practice. Rheumatology (Oxford) 42:919–923
Marks JS, Palmer MK, Burke MJ, Smith P (1978) Observer variation in examination of knee joints. Ann Rheum Dis 37:376–377
Lewis PA, O’Sullivan MM, Rumfeld WR, Coles EC, Jessop JD (1988) Significant changes in Ritchie scores. Br J Rheumatol 27:32–36
Thompson PW, Hart LE, Goldsmith CH, Spector TD, Bell MJ, Ramsden MF (1991) Comparison of four articular indices for use in clinical trials in rheumatoid arthritis: patient, order and observer variation. J Rheumatol 18:661–665
Hart LE, Tugwell P, Buchanan WW, Norman GR, Grace EM, Southwell D (1985) Grading of tenderness as a source of interrater error in the Ritchie articular index. J Rheumatol 12:716–717
Cushnaghan J, Cooper C, Dieppe P, Kirwan J, McAlindon T, McCrae F (1990) Clinical assessment of osteoarthritis of the knee. Ann Rheum Dis 49:768–770
Hart DJ, Spector TD, Brown P, Wilson P, Doyle DV, Silman AJ (1991) Clinical signs of early osteoarthritis: reproducibility and relation to X-ray changes in 541 women in the general population. Ann Rheum Dis 50:467–470
Jones A, Hopkinson N, Pattrick M, Berman P, Doherty M (1992) Evaluation of a method for clinically assessing osteoarthritis of the knee. Ann Rheum Dis 51:243–245
Hauzeur JP, Mathy L, De Maertelaer V (1999) Comparison between clinical evaluation and ultrasonography in detecting hydrarthrosis of the knee. J Rheumatol 26:2681–2683
Keen HI, Wakefield RJ, Grainger AJ, Hensor EM, Emery P, Conaghan PG (2008) Can ultrasonography improve on radiographic assessment in osteoarthritis of the hands? A comparison between radiographic and ultrasonographic detected pathology. Ann Rheum Dis 67:1116–1120
Keen HI, Wakefield RJ, Grainger AJ, Hensor EM, Emery P, Conaghan PG (2008) An ultrasonographic study of osteoarthritis of the hand: synovitis and its relationship to structural pathology and symptoms. Arthritis Rheum 59:1756–1763
Vlychou M, Koutroumpas A, Malizos K, Sakkas LI (2009) Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis. Osteoarthritis Cartilage 17:1283–1287
Tan AL, Grainger AJ, Tanner SF, Shelley DM, Pease C, Emery P, McGonagle D (2005) High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum 52:2355–2365
Grainger AJ, Farrant JM, O’Connor PJ, Tan AL, TAnner S, Emery P, McGonagle D (2007) MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive? Skeletal Radiol 36:737–745
Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Ostergaard M (2004) Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 50:2103–2112
Kane D, Balint PV, Sturrock RD (2003) Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. J Rheumatol 30:966–971
Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A (2005) Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 64:375–381
Wakefield RJ, Green MJ, Marzo-Ortega H, Conaghan PG, Gibbon WW, McGonagle D, Proudman S, Emery P (2004) Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 63:382–385
Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Gray R et al (1990) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 33:1601–1610
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
van Riel PLCM, van Gestel AM, Scott DL (2004) EULAR handbook of clinical assessment in rheumatoid arthritis, 3rd edn. Van Zuiden, Alphen Aan Den Rijn, pp 11–22
Maheu E, Altman RD, Bloch DA, Doherty M, Hochberg M, Mannoni A, Punzi L, Spector T, Verbruggen G, Carr A, Cicuttini F, Dreisser RL, Haraoui BP, Hart D, Pelletier JR, Ramonda R, Rovatti L (2006) Design and conduct of clinical trials in patients with osteoarthritis of the hand: recommendations from a task force of the Osteoarthritis Research Society International. Osteoarthritis Cartilage 14:303–322
Wakefield RJ, Balint PV, Szkudlarek M, Fillipucci E, Backhaus M, D’Agostino MA, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GA, Kane D, O’Connor PJ, Manger B, Joshua F, Koski J, Grassi W, Lassere MN, Swen N, Kainberger F, Klauser A, Ostergaard M, Brown AK, Machold KP, Conaghan PG (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487
McNally EG (2008) Ultrasound of the small joints of the hands and feet: current status. Skeletal Radiol 37:99–113
Dreisser RL, Maheu E, Guillou GB, Caspard H, Grouin JM (1995) Validation of an algofunctional index for osteoarthritis of the hand. Rev Rhum Engl Ed 62(6 Suppl 1):43S–53S
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Wieil C, Szkudlarek M, Hasselquist M, Moller JM, Vestergaard A, Norregaard J, Terslev L, Ostergaard M (2007) Ultrasonography, magnetic resonance imaging, radiography and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis. Arthritis Res Ther 9:R119
Mazieres B, Garnero P, Gueguen A, Abbal M, Berdah L, Lequesne M, Nguyen M, Salles JP, Vignon E, Dougados M (2006) Molecular markers of cartilage breakdown and synovitis at baseline as predictors of structural progression of hip osteoarthritis. The ECHODIAH Cohort. Ann Rheum Dis 65:354–9
Ayral X, Pickering EH, Woodworth TG, Mackillop N, Dougados M (2005) Synovitis: a potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis—results of a 1 year longitudinal arthroscopic study in 422 patients. Osteoarthritis Cartilage 13:361–367
Ayral X, Ravaud P, Bonvarlet JP, Simonnet J, Lecurieux R, Nguyen M, Sauvage E, Dougados M (1999) Arthroscopic evaluation of post-traumatic patellofemoral chondropathy. J Rheumatol 26:1140–1147
Dominick KL, Jordan JM, Renner JB, Kraus VB (2005) Relationship of radiographic and clinical variables to pinch and grip strength among individuals with osteoarthritis. Arthritis Rheum 52:1424–1430
Ozkan B, Keskin D, Bodur H, Barca N (2007) The effect of radiological hand osteoarthritis on hand function. Clin Rheumatol 26:1621–1625
Jones G, Cooley HM, Bellamy N (2001) A cross-sectional study of the association between Heberden’s nodes, radiographic osteoarthritis of the hands, grip strength, disability and pain. Osteoarthritis Cartilage 9:606–611
Sakkas LI, Platsoucas CD (2007) The role of T cells in the pathogenesis of osteoarthritis. Arthritis Rheum 56:409–424
Pelletier JP, Martel-Pelletier J, Abramson SB (2001) Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum 44:1237–1247
Walther M, Harms H, Krenn V, Radke S, Faehndrich TP, Gohlke F (2001) Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum 44:331–338
Walther M, Harms H, Krenn V, Radke S, Kirschner S, Gohlk F (2002) Synovial tissue of the hip at power Doppler US: correlation between vascularity and power Doppler US signal. Radiology 225:225–231
Tarhan S, Unlu Z (2003) Magnetic resonance imaging and ultrasonographic evaluation of the patients with knee osteoarthritis: a comparative study. Clin Rheumatol 22:181–188
Song IH, Burmester GR, Backhaus M, Althoff CE, Hermann KG, Schel AK, Werner C, Knetsch T, Schoenharting M (2008) Knee osteoarthritis. Efficacy of a new method of contrast-enhanced musculoskeletal ultrasonography in detection of synovitis in patienta with knee osteoarthritis in comparison with magnetic resonance imaging. Ann Rheum Dis 67:19–25
Terslev L, Torp-Pedersen F, Bang N, Koenig MJ, Nielsen MB, Bliddal H (2005) Doppler ultrasound findings in healthy wrists and finger joints before and after use of two different contrast agents. Ann Rheum Dis 64:824–827
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Koutroumpas, A.C., Alexiou, I.S., Vlychou, M. et al. Comparison between clinical and ultrasonographic assessment in patients with erosive osteoarthritis of the hands. Clin Rheumatol 29, 511–516 (2010). https://doi.org/10.1007/s10067-009-1348-z
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DOI: https://doi.org/10.1007/s10067-009-1348-z