Comparison between clinical and ultrasonographic assessment in patients with erosive osteoarthritis of the hands

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 (kappa = 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.

Role of diagnostic ultrasound in the assessment of musculoskeletal diseases

“…In addition, radiographic features of OA do not concord with the symptoms of OA [Felson, 2004;Hannan et al 2000]. US has been shown to be more sensitive than clinical examination in the detection of joint inflammation in patients with erosive OA [Koutroumpas et al 2010]. Synovitis detection in OA is considered important because its presence has been shown to be associated with pain [Hill et al 2001].…”

High‐resolution ultrasound in monitoring patients with osteoarthritis

“…HRMSUS was able to detect sinovitis in 24.1% of patients with erosive OA and this was in agreement with other studies, although the detection of synovitis may be technically more difficult in DIP joints and synovitis can be present in nonerosive OA. As a result, HRMSUS has been used as a gold standard to evaluate the reliability of the clinical examination in detecting inflammation in patients with erosive OA [Wittoek et al, 2010[Wittoek et al, , 2011Koutroumpas et al, 2010]. US detected synovitis was associated with more severe radiological damage and decreased cartilage thickness in patients with hand OA in a limited study of 25 patients.…”

Cartilage biology, pathology, and repair

“…However, the disease is frequently accompanied by inflammatory flares [154,155], and a variety of findings suggest that this inflammatory process contributes at least to the progression of OA [29]. Also, in different studies analyzing the effect of mechanical injury, chondrocytes have been shown to exert an increased expression of inflammatory mediators and stress response factors [49].…”