Comparison of Ultrasound, Radiography, and Clinical Investigations in the Diagnosis of Early Rheumatoid Synovitis in Patients with Nonspecific Musculoskeletal Symptoms: A Multicenter Cross-Sectional Study

Abstract

BackgroundEarly diagnosis and treatment of rheumatoid synovitis can reduce the progression of rheumatoid arthritis (RA). However, in the early stages of rheumatoid synovitis, patients may only have non-specific musculoskeletal symptoms, and plain film radiographs may not detect early synovial changes. The aim of this study was to compare the sensitivity and specificity of ultrasound with radiography, and clinical investigations in the detection of rheumatoid synovitis in patients presenting with nonspecific musculoskeletal symptoms.Material/MethodsThis was a non-randomized, cross-sectional, clinical study that included 189 patients who had nonspecific musculoskeletal symptoms. All patients underwent clinical investigations, postero-anterior and dorsal radiographic imaging, and bilateral grey-scale ultrasound examinations of the third and second metacarpophalangeal (MCP) joints, the third and the second proximal interphalangeal (PIP) joints, the second and the fifth metatarsophalangeal (MTP) joints, and the wrist.ResultsThere was no clear predictive value for detection of early synovitis by clinical investigations alone. Plain film radiography of patients only provided accurate information of joint erosions but less information for synovitis. Grey-scale ultrasound was more effective at detecting early synovitis compared with clinical investigations (p=0.00015; q=4.548) and compared with plain film radiography (p=0.0002; q=4.537), and quantified the synovial changes. The predictive values of plain film radiography and clinical investigations had 0.43 and 0.24 sensitivity and 0 specificity compared with ultrasound.ConclusionsThe findings of this study support the use of grey-scale ultrasound in the detection of early rheumatoid synovitis of the fingers and the wrist.

The importance of ultrasound examination in early arthritis

“…The importance of the assessment of synovitis by GS was underlined by Ying-hua Zang et al [20]. The researchers assessed 189 patients with non-specific ailments of the musculoskeletal system, and compared sensitivity and specificity of US, radiographic methods, and the clinical examination.…”

Management of rheumatoid arthritis: 2019 updated consensus recommendations from the Hong Kong Society of Rheumatology

“…The combined gray-scale and power Doppler are validated for histological synovitis [112][113][114]. Observational studies have shown MSUS to be more effective than clinical examination for the detection of synovitis [114][115][116][117][118]. When there is diagnostic doubt, MSUS has been recommended to improve the certainty of a diagnosis of RA above 1 Use glucocorticoids as bridging therapy with csDMARDs until the csDMARD reaches its full effect; ideally discontinue glucocorticoids within 3-6 months.…”

Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery

“…A study was conducted by Zhang et al (2018) to determine if radiographs and ultrasound can be used in the detection of rheumatoid arthritis. They found that radiographs were not sensitive enough to pick up the subtle changes in the joint structure (Zhang et al 2018). On the other hand, ultrasound was found to be effective at detecting early synovitis (Zhang et al 2018).…”

“…They found that radiographs were not sensitive enough to pick up the subtle changes in the joint structure (Zhang et al 2018). On the other hand, ultrasound was found to be effective at detecting early synovitis (Zhang et al 2018).…”