TY - JOUR
T1 - An ultrasound negative for subclinical synovitis in arthralgia patients
T2 - is it helpful in identifying those not developing arthritis?
AU - Rogier, Cleo
AU - Frazzei, Giulia
AU - Kortekaas, Marion C.
AU - Verstappen, Marloes
AU - Ohrndorf, Sarah
AU - van Mulligen, Elise
AU - van Vollenhoven, Ronald F.
AU - van Schaardenburg, Dirkjan
AU - de Jong, Pascal H. P.
AU - van der Helm-van Mil, Annette H. M.
N1 - Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2022/11/28
Y1 - 2022/11/28
N2 - OBJECTIVE: To investigate the negative predictive value (NPV) of musculoskeletal US (MSUS) in arthralgia patients at risk for developing inflammatory arthritis. METHODS: An MSUS examination of hands and feet was performed in arthralgia patients at risk for inflammatory arthritis in four independent cohorts. Patients were followed for one-year on the development of inflammatory arthritis. Subclinical synovitis was defined as greyscale ≥2 and/or power Doppler ≥1. NPVs were determined and compared with the prior risks of not developing inflammatory arthritis. Outcomes were pooled using meta-analyses and meta-regression analyses. In sensitivity analyses, MSUS imaging of tender joints only (rather than the full US protocol) was analysed and ACPA stratification applied. RESULTS: After 1 year 78, 82, 77 and 72% of patients in the four cohorts did not develop inflammatory arthritis. The NPV of a negative US was 86, 85, 82 and 90%, respectively. The meta-analysis showed a pooled non-inflammatory arthritis prevalence of 79% (95% CI 75%, 83%) and a pooled NPV of 86% (95% CI 81, 89%). Imaging tender joints only (as generally done in clinical practice) and ACPA stratification showed similar results. CONCLUSION: A negative US result in arthralgia has a high NPV for not developing inflammatory arthritis, which is mainly due to the high a priori risk of not developing inflammatory arthritis. The added value of a negative US (<10% increase) was limited.
AB - OBJECTIVE: To investigate the negative predictive value (NPV) of musculoskeletal US (MSUS) in arthralgia patients at risk for developing inflammatory arthritis. METHODS: An MSUS examination of hands and feet was performed in arthralgia patients at risk for inflammatory arthritis in four independent cohorts. Patients were followed for one-year on the development of inflammatory arthritis. Subclinical synovitis was defined as greyscale ≥2 and/or power Doppler ≥1. NPVs were determined and compared with the prior risks of not developing inflammatory arthritis. Outcomes were pooled using meta-analyses and meta-regression analyses. In sensitivity analyses, MSUS imaging of tender joints only (rather than the full US protocol) was analysed and ACPA stratification applied. RESULTS: After 1 year 78, 82, 77 and 72% of patients in the four cohorts did not develop inflammatory arthritis. The NPV of a negative US was 86, 85, 82 and 90%, respectively. The meta-analysis showed a pooled non-inflammatory arthritis prevalence of 79% (95% CI 75%, 83%) and a pooled NPV of 86% (95% CI 81, 89%). Imaging tender joints only (as generally done in clinical practice) and ACPA stratification showed similar results. CONCLUSION: A negative US result in arthralgia has a high NPV for not developing inflammatory arthritis, which is mainly due to the high a priori risk of not developing inflammatory arthritis. The added value of a negative US (<10% increase) was limited.
KW - RA
KW - arthralgia
KW - inflammatory arthritis
KW - outcome assessment healthcare
KW - power Doppler
KW - ultrasonography
UR - http://www.scopus.com/inward/record.url?scp=85143088367&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/rheumatology/keac239
DO - https://doi.org/10.1093/rheumatology/keac239
M3 - Article
C2 - 35416958
SN - 1462-0324
VL - 61
SP - 4892
EP - 4897
JO - Rheumatology (Oxford, England)
JF - Rheumatology (Oxford, England)
IS - 12
ER -