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Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis--a probabilistic approach.

Rezaei H, Torp-Pedersen S, af Klint E, Backheden M, Kisten Y, Györi N, van Vollenhoven RF - Arthritis Res. Ther. (2014)

Bottom Line: Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints 2 to 5 in both hands, metatarsophalangeal (MTP) joints 2 to 5 in both feet and any symptomatic joints was performed and the results presented to the same rheumatologist.With regard to a diagnosis of RA, the proportions were 31.1% pre-test and 61.2% post-test (P <0.001).MSUS findings agreed with the final diagnosis in 95% of patients.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: This study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach.

Methods: One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis were included. Patients were assessed clinically including joint examination, laboratory testing including acute-phase reactants, rheumatoid factor (RF) and anti citrulinated protein antibody (ACPA), and radiographs of hands and feet if clinically indicated. A diagnostic assessment was then performed by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints 2 to 5 in both hands, metatarsophalangeal (MTP) joints 2 to 5 in both feet and any symptomatic joints was performed and the results presented to the same rheumatologist. The latter then assessed the diagnostic probabilities again, using the same scale.

Results: The rheumatologists' certainty for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P <0.001). With regard to a diagnosis of RA, the proportions were 31.1% pre-test and 61.2% post-test (P <0.001). MSUS findings agreed with the final diagnosis in 95% of patients.

Conclusion: Musculoskeletal ultrasound, when added to routine rheumatologic investigation, greatly increases the diagnostic certainty in patients referred for the evaluation of inflammatory arthritis. The changes from pre-test to post-test probability quantify the diagnostic utility of musculoskeletal ultrasound in probabilistic terms.

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Related in: MedlinePlus

Proportion of patients with a different final diagnosis in pre-test (A) and post-test (B) evaluation of likelihood of inflammatory arthritis. The percentages above the columns show the fraction of inflammatory arthritis within each column. RA, rheumatoid arthritis.
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Fig3: Proportion of patients with a different final diagnosis in pre-test (A) and post-test (B) evaluation of likelihood of inflammatory arthritis. The percentages above the columns show the fraction of inflammatory arthritis within each column. RA, rheumatoid arthritis.

Mentions: Overall, of the patients who were included in the study 65% were diagnosed with any inflammatory arthritis and 36.9% with RA. Figure 3 demonstrates the final diagnosis in the groups categorized by pre-test and post-test likelihoods and how these initial risks changed within the groups to higher or lower risks in post-test evaluation. As shown, the rheumatologists’ pre-MSUS evaluation was significantly less accurate when compared to the final diagnosis, and was particularly wanting in being able to identify with confidence those patients without inflammatory arthritis.Figure 3


Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis--a probabilistic approach.

Rezaei H, Torp-Pedersen S, af Klint E, Backheden M, Kisten Y, Györi N, van Vollenhoven RF - Arthritis Res. Ther. (2014)

Proportion of patients with a different final diagnosis in pre-test (A) and post-test (B) evaluation of likelihood of inflammatory arthritis. The percentages above the columns show the fraction of inflammatory arthritis within each column. RA, rheumatoid arthritis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4209056&req=5

Fig3: Proportion of patients with a different final diagnosis in pre-test (A) and post-test (B) evaluation of likelihood of inflammatory arthritis. The percentages above the columns show the fraction of inflammatory arthritis within each column. RA, rheumatoid arthritis.
Mentions: Overall, of the patients who were included in the study 65% were diagnosed with any inflammatory arthritis and 36.9% with RA. Figure 3 demonstrates the final diagnosis in the groups categorized by pre-test and post-test likelihoods and how these initial risks changed within the groups to higher or lower risks in post-test evaluation. As shown, the rheumatologists’ pre-MSUS evaluation was significantly less accurate when compared to the final diagnosis, and was particularly wanting in being able to identify with confidence those patients without inflammatory arthritis.Figure 3

Bottom Line: Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints 2 to 5 in both hands, metatarsophalangeal (MTP) joints 2 to 5 in both feet and any symptomatic joints was performed and the results presented to the same rheumatologist.With regard to a diagnosis of RA, the proportions were 31.1% pre-test and 61.2% post-test (P <0.001).MSUS findings agreed with the final diagnosis in 95% of patients.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: This study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach.

Methods: One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis were included. Patients were assessed clinically including joint examination, laboratory testing including acute-phase reactants, rheumatoid factor (RF) and anti citrulinated protein antibody (ACPA), and radiographs of hands and feet if clinically indicated. A diagnostic assessment was then performed by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints 2 to 5 in both hands, metatarsophalangeal (MTP) joints 2 to 5 in both feet and any symptomatic joints was performed and the results presented to the same rheumatologist. The latter then assessed the diagnostic probabilities again, using the same scale.

Results: The rheumatologists' certainty for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P <0.001). With regard to a diagnosis of RA, the proportions were 31.1% pre-test and 61.2% post-test (P <0.001). MSUS findings agreed with the final diagnosis in 95% of patients.

Conclusion: Musculoskeletal ultrasound, when added to routine rheumatologic investigation, greatly increases the diagnostic certainty in patients referred for the evaluation of inflammatory arthritis. The changes from pre-test to post-test probability quantify the diagnostic utility of musculoskeletal ultrasound in probabilistic terms.

Show MeSH
Related in: MedlinePlus