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Patient-reported tender, swollen joint counts did not accurately reflect synovitis
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The sensitivity of patient-reported tender and swollen joints to predict true synovitis is low overall but strongest in a setting of low rheumatoid arthritis activity without erosive disease, according to recent data.
Researchers used power Doppler ultrasound (PDUS) assessments of 50 rheumatoid arthritis (RA) patients, including 28 self-assessed tender and swollen joints. They analyzed the relationship of these joints with active synovitis by: percentage agreement at each PDUS semiquantitative grade, positive likelihood ratio (LR) of agreement with PDUS and LR of agreement with PDUS based on radiographic damage.
Using Spearman’s correlation and sensitivity analyses, researchers associated tender and swollen joint counts with disease activity markers. Level of agreement also was analyzed relative to Disease Activity Score 28 (DAS28) level or global pain.
Seventy-five percent of joints with grade 3 PDUS were identified by patients as tender, 63% as swollen.
In cases with no significant radiographic damage detected, swollen joints were strongly associated with active synovitis (LR=2.54; 95% CI, 1.93-3.34), but less association was found in cases with significant radiographic damage (LR=1.32; 95% CI, 0.75-2.32).
“Swollen joint counts were statistically correlated with PDUS-DAS28 and C-reactive protein, but not PDUS score,” the researchers wrote.
Better agreement of tender and swollen joints with active synovitis was shown when DAS28 was no more than 3.2 and when patient global pain was less than 50 mm on visual analog scale.
“The sensitivity of patient-reported joints to detect true synovitis is low; however, the high specificity suggests that tender or swollen joints reported by patients could be an alert signal that there may be clinically relevant inflammation,” the researchers concluded.
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