The diagnostic accuracy of the squeeze test to identify arthritis: a cross-sectional cohort study

Bosch, Wytse B. van den; Mangnus, L.; Reijnierse, M.; Huizinga, T.W.J.; Mil, Annette H M van der Helm-van

doi:10.1136/annrheumdis-2014-207202

Cited by 22 publications

(15 citation statements)

References 17 publications

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“…We read with deep interest the article by van den Bosch et al 1 related to the diagnostic accuracy of the squeeze test to identify arthritis. This cross-sectional cohort study suggested that a positive squeeze test is associated with local joint inflammation with a very low sensitivity, indicating a high percentage of swollen joints with a negative squeeze test.…”

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confidence: 99%

“…First, the authors added proximal interphalangeal joints (PIPs) symptoms as positive physical examination, but there lacked the results of squeeze test about PIPs. Second, ‘the squeeze test’ described by the authors in figure 11 isn’t the ‘validated standard squeeze test’ promoted by experts and societies 2–4. The interphalangeal joints of the hands and feet are held by hand and their pain will lead to a false-positive squeeze test.…”

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confidence: 99%

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The significance of the squeeze test to identify arthritis was underestimated or not?

Luo

Zeng

2015

Ann Rheum Dis

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confidence: 99%

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confidence: 99%

The significance of the squeeze test to identify arthritis was underestimated or not?

Luo

Zeng

2015

Ann Rheum Dis

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“…Adding other clinical variables might increase the discriminative ability of the model. Potential examples include the squeeze test of the metacarpophalangeal joints (although the diagnostic accuracy was shown to be only moderate 28 ), information on family history or functional impairments. These items were not routinely collected before December 2015.…”

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confidence: 99%

Development and validation of a clinical rule for recognition of early inflammatory arthritis

et al. 2018

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ObjectivesNational and international guidelines recommend prompt referral of patients presenting with inflammatory arthritis (IA), but general practitioners (GPs) feel uncertain in their proficiency to detect synovitis through joint examination, the method of choice to identify IA. Our objective was to develop and validate a rule composed of clinical characteristics to assist GPs and other physicians in identifying IA when in doubt.DesignSplit-sample derivation and validation study.SettingThe Leiden Early Arthritis Recognition Clinic (EARC), a screening clinic for patients in whom GPs suspected but were unsure of the presence of IA.Participants1288 consecutive patients visiting the EARC.Primary and secondary outcome measuresAssociations of clinical characteristics with presence of IA were determined using logistic regression in 644 patients, while validating the results in the other 644 patients (split-sample validation). To facilitate application in clinical practice, a simplified rule (with scores ranging from 0 to 7.5) was derived and validated.ResultsIA was identified by a rheumatologist in 41% of patients. In univariable analysis, male gender, age ≥60 years, symptom duration <6 weeks, morning stiffness >60 min, a low number of painful joints (1–3 joints), presence of patient-reported joint swelling and difficulty with making a fist were associated with IA in the derivation data set. Using multivariable analysis, a simplified rule consisting of these seven items was derived and validated, yielding an area under the receiver operator characteristic curve (AUC) of 0.74 (95% CI 0.70 to 0.78) in the derivation data set. Validation yielded an AUC of 0.71 (95% CI 0.67 to 0.75). Finally, the model was repeated to study predicted probabilities with a lower prevalence of inflammatory arthritis to simulate performance in primary care settings.ConclusionsOur rule, composed of clinical parameters, had reasonable discriminative ability for IA and could assist physicians in decision-making in patients with suspected IA, increasing appropriateness of healthcare utilisation.

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“…The rationale for the squeeze test is that compression of the metacarpophalangeal (MCP) joints evokes pain in an individual with active synovitis. We agree that the squeeze test is useful for identifying early arthritis,4 but its sensitivity is limited and it may need to be combined with other screening tests in order to be sufficiently discriminatory 5. Nonetheless, it is cheap, quick and easy to perform and therefore an appropriate test for the GP who suspects a patient may have developed RA.…”

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confidence: 80%

Imminent rheumatoid arthritis can be identified in primary care

Mankia

Emery

2017

Ann Rheum Dis

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Imminent rheumatoid arthritis can be identified in primary careWe thank Vega-Morales et al 1 for their interest in our proposed approach for identifying individuals at risk of rheumatoid arthritis (RA) in a primary care setting.2 3 The authors agree that primary care is usually the first point of contact for patients with RA when they initially develop symptoms. For this reason, they agree that general practitioners (GPs) are well placed to be involved in screening strategies to identify individuals at risk of progressing to RA.

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The diagnostic accuracy of the squeeze test to identify arthritis: a cross-sectional cohort study

Abstract: A positive squeeze test is associated with local joint inflammation but the sensitivity is low, indicating a high percentage of swollen joints with a negative squeeze test. When the test is used on its own, it is insufficient to detect early arthritis.

Cited by 22 publications

References 17 publications

The significance of the squeeze test to identify arthritis was underestimated or not?

The significance of the squeeze test to identify arthritis was underestimated or not?

Development and validation of a clinical rule for recognition of early inflammatory arthritis

Imminent rheumatoid arthritis can be identified in primary care

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