Musculoskeletal ultrasonography assists the diagnostic performance of the 2010 classification criteria for rheumatoid arthritis

• Published in: Modern rheumatology 2013-01, Vol.23 (1), p.36-43
• Main Authors: Kawashiri, Shin-ya, Suzuki, Takahisa, Okada, Akitomo, Yamasaki, Satoshi, Tamai, Mami, Nakamura, Hideki, Origuchi, Tomoki, Mizokami, Akinari, Uetani, Masataka, Aoyagi, Kiyoshi, Eguchi, Katsumi, Kawakami, Atsushi
• Format: Article
• Language: English
• Subjects: Algorithms; Arthritis, Rheumatoid - classification; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - diagnostic imaging; Classification; Female; Finger Joint - diagnostic imaging; Finger Joint - pathology; Finger Joint - physiopathology; Humans; Magnetic Resonance Imaging; Male; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Performance evaluation; Rheumatoid arthritis; Rheumatology; Ultrasonic imaging; Ultrasonography, Doppler - methods; Wrist Joint - diagnostic imaging; Wrist Joint - pathology; Wrist Joint - physiopathology
• ISSN: 1439-7595; 1439-7609
• DOI: 10.1007/s10165-012-0628-7

Objective We investigated whether musculoskeletal ultrasonography (MSKUS) assists the diagnostic performance of the 2010 rheumatoid arthritis (RA) classification criteria. Methods Sixty-nine early arthritis patients were consecutively enrolled. None of the patients had been treated. In MSKUS of bilateral wrist and finger joints from 22 sites, the findings obtained by gray-scale and power Doppler (PD) assessment were graded on a semiquantitative scale from 0 to 3. Plain magnetic resonance imaging (MRI) of both wrist and finger joints was also examined. Diagnosis of RA was defined by the initiation of disease-modifying antirheumatic drugs within the first 3 months. The diagnostic performance of the patients was evaluated at entry using 2010 RA classification criteria in conjunction with MSKUS. Results The indispensable MSKUS finding for differentiating RA was the presence of a PD grade 2 or 3 that was superior to 2010 RA classification criteria or MRI-proven bone edema. We propose that the decision tree algorithm of 2010 RA classification criteria with PD grade 2 or 3 reveals the best discriminative ability. Conclusion MSKUS, especially with a strong PD signal, is very useful to assist the diagnostic performance of the 2010 RA classification criteria in the early recognition of RA.