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No added predictive value attributed to use of musculoskeletal ultrasound in early arthritis patients
The use of musculoskeletal ultrasound added to routine clinical parameters failed to serve as a significantly superior predictor of persistent inflammatory arthritis among early arthritis patients in a recent study.
Researchers in the UK conducted a retrospective study of 379 patients (aged 16 years and older; 69% female) with early arthritis who presented with inflammatory arthralgia but no evidence of swollen joints. The cohort was followed for at least 12 months (median 28 months), during which 162 patients developed persistent inflammatory arthritis (PIA).
A 10-minute musculoskeletal ultrasound (MSUS) at baseline evaluated 16 peripheral small joints in all patients. Logistic regression established two risk metrics that predicted the development of PIA with and without MSUS data inclusion. Twelve clinical and serological parameters, including age, gender, swollen and tender joint counts, C-reactive protein and erythrocyte sedimentation rate, conducted at baseline provided a vehicle to determine PIA outcome.
Seven variables were independently associated with PIA (P<.001). By incorporating them in backward stepwise logistic regression analysis, researchers determined an area under ROC curve of 0.91 (95% CI, 0.88-0.94). Using the second metric that included the routine variables plus data from five MSUS parameters, researchers said the area under ROC curve was equal to but not significantly superior (0.91; 95% CI, 0.89-0.94) in projecting PIA.
“MSUS use as a routine component of assessment in an early arthritis clinic did not add substantial discriminatory value to a risk metric for predicting PIA,” the researchers concluded. “We were unable to demonstrate [MSUS’] enhanced ability to predict PIA in a sub-cohort of EA clinic attendees who present without clinical evidence of swollen/inflamed joints, or to predict progression to RA amongst those individuals who present with [undifferentiated arthritis].”
Disclosure: The researchers report no relevant financial disclosures.