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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. Jane E Freeston (jefreeston{at}
  1. University of Leeds, United Kingdom
    1. Richard J Wakefield (medrjw{at}
    1. University of Leeds, United Kingdom
      1. Philip G Conaghan (p.conaghan{at}
      1. University of Leeds, United Kingdom
        1. Elizabeth M A Hensor (e.m.a.hensor{at}
        1. University of Leeds, United Kingdom
          1. Sheena P Stewart (sps{at}
          1. University of Leeds, United Kingdom
            1. Paul Emery (p.emery{at}
            1. University of Leeds, United Kingdom


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

              Methods: 50 patients with ≤12 weeks of inflammatory symptoms +/- 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 RF and/or CCP positive patients developed persistent IA so the added value of PDUS was assessed in the sero-negative (RF and CCP negative) group. The probability of IA in a sero-negative patient was 6%. The addition of clinical and radiographic features raised the probability of IA to 30% and with certain US features this rose to 94%.

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

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