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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (6): 1037-1042. doi: 10.19723/j.issn.1671-167X.2021.06.005

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Agreement between ultrasound-detected inflammation and clinical signs in ankles and feet joints in patients with rheumatoid arthritis

DENG Xue-rong,SUN Xiao-ying,ZHANG Zhuo-li()   

  1. Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China
  • Received:2021-09-10 Online:2021-12-18 Published:2021-12-13
  • Contact: Zhuo-li ZHANG E-mail:zhuoli.zhang@126.com
  • Supported by:
    Youth Clinical Research Project of Peking University First Hospital(2018CR04)

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Abstract:

Objective: To investigate the agreement between clinical signs (tenderness and/or swelling) in ankles and feet joints and ultrasound findings in patients with rheumatoid arthritis (RA). Methods: RA patients with at least 1 tender and/or swollen joint in bilateral ankles and metatarsophalangeal (MTP) joints detected by physical examination were enrolled and underwent ultrasound examination by greyscale (GS) and power Doppler (PD) mode. The agreement between clinical signs and ultrasound-detected inflammation (joint effusion, synovitis, or tenosynovitis) was analyzed. Results: In the study, 113 consecutive RA patients were included, with mean age of (52.5±12.6) years, median duration of 60 (13, 129) months, mean disease activity score in 28 joints based on erythrocyte sedimentation rate [DAS28 (ESR)] of 5.1±1.7,mean disease activity score in 28 joints based on C reactive protein[DAS28 (CRP)]of 4.6±1.5. The tenderness and swelling was most commonly detected in ankles (52.7% and 31.9%, respectively), while GS (+) synovitis was most frequently detectable in MTP2 (34.1%), followed by ankles (32.7%) and MTP1 (27.9%),and PD (+) synovitis was most frequently detectable in MTP1 (14.2%), followed by ankles (12.4%) and MTP2 (10.6%). The prevalence of tenosynovitis was 41.1%, which mostly located in tibialis posterior tendon (22.1% of GS positive and 17.6% of PD positive). The highest prevalence of joint effusion was detected in ankles (9.7%), while that of bone erosion in MTP5 (19%). The overall concordance rate between positive clinical signs and ultrasound-determined joint inflammation was poor in the above joints (κ<0.2, P<0.05), in which swelling had the highest κ coefficient with ultrasound-determined joint inflammation in ankles (κ=0.225, P<0.05). Moreover, swelling had the highest κ coefficient with synovitis in ankles (κ=0.231, P<0.05).The concordance between tenosynovitis and signs in ankles was also poor (κ<0.20, P<0.05). There was no significant agreement between joint effusion and clinical signs (P>0.05). Conclusion: The overall concordance between clinical signs and inflammation on ultrasound was poor in ankles and feet joints. Tenderness and swelling was more common in ankles, while more lesions were detected by ultrasound at MTP joints. Ultrasound is useful in assessing the lesions besides physical examination in patients with RA.

Key words: Arthritis, rheumatoid, Ankles and feet joints, Ultrasound

CLC Number: 

  • R593.22

Table 1

Clinical characteristic of 113 patients with rheumatoid arthritis"

Items Values
n 113
Age/year, $\overline{x}$±s 52.5 ± 12.6
Female, n (%) 93 (82.3)
Disease duration/months, M (P25,P75) 60.0 (13-129)
PGA/mm, $\overline{x}$±s 55.9±25.1
EGA/mm, $\overline{x}$±s 48.5±24.3
HAQ, M (P25,P75) 12.0 (3.5-23.5)
ESR/(mm/h), M (P25,P75) 35 (19-65)
CRP/(mg/L), M (P25,P75) 11.9 (5.5-36.4)
DAS28 (ESR), $\overline{x}$±s 5.1±1.7
DAS28 (CRP), $\overline{x}$±s 4.6±1.5
CDAI, $\overline{x}$±s 22.8±14.2
SDAI, $\overline{x}$±s 25.1±16.4

Table 2

Frequencies of clinical signs in bilateral ankles and feet joints"

Joint Tenderness Swelling
n % n %
Ankle 715 52.7 432 31.9
MTP1 244 18.1 108 8.0
MTP2 252 18.6 47 3.5
MTP3 591 21.7 40 3.1
MTP4 501 21.2 40 3.1
MTP5 538 22.6 80 6.2

Table 3

Frequencies of lesions detected by ultrasound in bilateral ankles and feet joints"

Joint GS (+)
synovitis/%		 PD (+)
synovitis/%		 Effusion/% Bone erosion/%
Ankle 32.7 12.4 9.7 11.5
MTP1 27.9 14.2 4.0 16.4
MTP2 34.1 10.6 2.7 1.3
MTP3 23.0 8.0 0.9 0.9
MTP4 14.2 5.8 0 0.9
MTP5 11.5 9.3 0 19.0

Table 4

Concordance between clinical signs and ultrasound-detected inflammation at each joint"

Joint Number of joints κ P
PE+/US+ PE+/US- PE-/US+ PE-/US-
Ankle 84 50 41 51 0.178 0.007
MTP1 14 31 58 123 -0.008 0.904
MTP2 21 22 59 124 0.125 0.041
MTP3 13 40 40 133 0.089 0.181
MTP4 13 35 20 158 0.179 0.006
MTP5 11 44 15 156 0.137 0.023

Table 5

Concordance between positive signs and ultrasound-detected inflammation at each joint"

Joint Tenderness (+) & US (+) Swelling (+) & US (+)
κ P κ P
Ankle 0.128 0.054 0.225 0.000
MTP1 -0.024 0.694 0.058 0.232
MTP2 0.111 0.066 0.028 0.579
MTP3 0.083 0.033 0.014 0.832
MTP4 0.210 0.000 0.179 0.006
MTP5 0.127 0.039 0.079 0.230

Table 6

Concordance between clinical signs and synovitis at each joint"

Joint T/S (+) & synovitis T (+) & synovitis S (+) & synovitis
κ P κ P κ P
Ankle 0.069 0.234 0.018 0.769 0.231 0.001
MTP1 -0.037 0.566 0.060 0.350 0.056 0.277
MTP2 0.118 0.056 0.104 0.091 0.032 0.333
MTP3 0.020 0.764 0.095 0.153 0.086 0.029
MTP4 0.187 0.004 0.187 0.004 0.217 0.000
MTP5 0.137 0.023 0.127 0.039 0.076 0.230

Table 7

Concordance between clinical signs and tenosynovitis at ankle"

Items κ P
T/S (+) & GS (+) tenosynovitis 0.146 0.008
T/S (+) & PD (+) tenosynovitis 0.136 0.008
T (+) & GS (+) tenosynovitis 0.126 0.034
T(+) & PD (+) tenosynovitis 0.121 0.029
S(+) & GS (+) tenosynovitis 0.083 0.212
S(+) & PD (+) tenosynovitis 0.097 0.136
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