The additional benefit of ultrasonography to 2010 ACR/EULAR classification criteria when diagnosing rheumatoid arthritis in the absence of anti-cyclic citrullinated peptide antibodies

Abstract

The aim of this study was to assess the benefit of ultrasonography (US) contributing to 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria in diagnosing rheumatoid arthritis (RA), when anti-citrullinated protein (CCP) antibody and radiographic erosions are absent. Ninety-four patients suffering from arthritis of at least one joint in hands, symptom duration of less than 2 years, normal radiographs at baseline, and negative anti-CCP had 22 joint US assessments and were followed prospectively for at least 12 months. Sensitivity and specificity for final RA diagnosis based on 1987 RA criteria were determined for ultrasound variables. Logistic regression models were then fitted to evaluate predictive ability over and above the 2010 ACR/EULAR classification criteria. Twenty-nine of them were classified as RA patients and 65 had alternative diagnoses. There were significantly more joints with synovial hypertrophy, synovitis, and bone erosion detected by US in RA patients. The gray-scale (GS) variables positively correlated with acute phase reactants. The area under curve (AUC) values of GS and power Doppler (PD) were comparable, higher than bone erosion. However, regression analysis demonstrated that only PD involvement of joints, especially wrists, provided independently predictive data, with improved AUC values from 0.738 to 0.872 combined with 2010 ACR/EULAR classification criteria. PD scanning of hand joints, especially wrists, may provide independently assistance to 2010 ACR/EULAR criteria in the early diagnosis of RA in those patients who are negative for anti-CCP antibody.

Back to the future: forget ultrasound and focus on clinical assessment in rheumatoid arthritis management

“…The added value of US has been advocated at all levels of the disease stages4: from predicting diagnosis,1 to supporting the diagnostic and classification process,5 guiding treatment choices and response,6 predicting structural damage and flares,7 8 and influencing the concept and management of remission and treatment tapering 9 10. US has been shown to be superior to clinical assessment in detecting inflammation by assessing the presence of the most important elementary lesions in RA: synovial hypertrophy (SH), synovial effusion (SE) and Power Doppler activity (PD) 2.…”

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

“…Early RA is characterized by synovitis [6], but it may be difficult to detect subclinical synovitis during physical examination [178]. ACPA and MSUS are valuable tools to aid early diagnosis of RA [179][180][181].…”

The use of MRI-detected synovitis to determine the number of involved joints for the 2010 ACR/EULAR classification criteria for Rheumatoid Arthritis – is it of additional benefit?

“…In two studies the presence of clinically evident inflammatory arthritis was not required for inclusion. [12, 13] Another study showed associations between ultrasound-detected synovitis and fulfilment of the 2010-criteria, but test characteristics with and without the use of ultrasound were not provided. [15] One study calculated test characteristics and showed that the use of ultrasound resulted in an increased sensitivity at the cost of specificity, which is in line with our findings.…”