Inter-observer agreement of standard joint counts in early rheumatoid arthritis: a comparison with grey scale ultrasonography—a preliminary study

Objectives. The aims of the present study were to assess the inter-observer agreement of standard joint count and to compare clinical examination with grey scale ultrasonography (US) findings in patients with early rheumatoid arthritis (RA). Methods. The study was conducted on 44 RA patients with a disease duration of <2yrs. Clinical evaluation was performed independently by two rheumatologists for detection of tenderness in 44 joints and swelling in 42 joints. All patients underwent US assessment by a rheumatologist experienced in this method and blinded to the clinical findings. Joint inflammation was detected by US when synovial fluid and/or synovial hypertrophy was identified using OMERACT preliminary definitions. The inter-observer reliability was calculated by overall agreement (percentage of observed exact agreement) and kappa (� )-statistics. The reliability of US was calculated in 12 RA patients. Results. There was fair to moderate inter-observer agreement on individual joint counts for either tenderness or joint swelling apart from the glenohumeral joint. US detected a higher number of inflamed joints than did clinical examination. The mean (� S.D.) US joint count for joint inflammation was 19.1 (� 4.1), while the mean (� S.D.) number of swollen joints was 12.6 (� 3.6), with a significant difference of P ¼0.01. Conclusions. Our results provide evidence in favour of the hypothesis that clinical examination is far from optimal for asessing joint inflammation in patients with early RA. Furthermore, this study suggests that US can considerably improve the detection of signs of joint inflammation both in terms of sensitivity and reliability

Ultrasound imaging for the rheumatologist II. Ultrasonography of the hand and wrist

The hand is one of the anatomical regions most frequently explored by ultrasonography (US) in rheumatology. The last generation US systems equipped with high frequency probes allow for a quick and accurate assessment of even minimal pathological changes in patients with rheumatic conditions affecting the small joints and the sofa tissues of the hand and wrist. Several studies have demonstrated the great value of US imaging of the hand and wrist in rheumatology but there are still controversial issues which yet have to be adequately addressed, particularly with regard to US semi-quantitative evaluation of synovitis and bone erosions in patients with chronic arthritis. This paper provides the basic knowledge, reviews the available evidence and discusses the potential of US in the evaluation of the hand and wrist

Ultrasound imaging for the rheumatologist XXX. Sonographic assessment of the painful knee

The knee joint is a frequent focus of attention for rheumatologists when assessing patients presenting to a clinic and may represent underlying intra-articular inflammatory pathology or involvement of the surrounding soft tissues. This study describes the correlation between clinical and ultrasound findings in patients presenting with a variety of rheumatic disorders and knee pain. US imaging provides for a sensitive and detailed identification of different intra-and peri-articular pathology responsible for knee pain

Ultrasound imaging for the rheumatologist IX. Ultrasound imaging in spondyloarthritis

Musculoskeletal ultrasound (US) has an increasingly important role in the assessment of spondyloarthritis (SPA) not only for its ability to detect synovial and tendon involvement but also for the accurate imaging of enthesitis, the clinical hallmark feature of SpA. As already known, most cases of enthesitis are subclinical in SpA and US is an effective technique used to detect them. Also, in cases of dactylitis, US can accurately delineate the underlying pathology. US allows clinicians to guide needle positioning within inflamed joints, tendon sheaths and entheses in order to inject steroids or other drugs. This is particularly important for patients with SpA, because of the frequency of mono or oligoarthritis, tendon and entheseal involvement, who may have great benefit from intrarticular or intralesional therapy. The clinical application of US in SpA extends to the monitoring of therapy efficacy, particularly when coupled with power Doppler imaging. Very slight changes in vascularity are easily detected in joints, entheses or tendons, aiding the rheumatologist in the assessment of the effects of local or systemic therapies. The present review provides an update of the available data and discusses research issues of US imaging in SPA. © Copyright Clinical and Experimental Rheumatology 2007