A Diagnostic Algorithm for Persistence of Very Early Inflammatory Arthritis: the Utility of Power Doppler Ultrasound when Added to Conventional Assessment Tools

Overview

Journal Ann Rheum Dis

Specialty Rheumatology

Date 2009 Apr 11

PMID 19359260

Citations 52

Authors

J E Freeston

R J Wakefield

P G Conaghan

E M A Hensor

S P Stewart

P Emery

Affiliations

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Abstract

Objectives: The aim of this study was to assess the value of power Doppler ultrasound (PDUS) in combination with routine management in a cohort of patients with very early inflammatory arthritis (IA).

Methods: 50 patients with < or =12 weeks of inflammatory symptoms with or without signs had clinical, laboratory and imaging assessments. Diagnosis was recorded at 12 months. Assuming a 15% pre-test probability of IA, post-test probabilities for various assessments were calculated and used to develop a diagnostic algorithm.

Results: All patients positive for rheumatoid factor (RF) and/or cyclic citrullinated peptide (CCP) developed persistent IA, so the added value of PDUS was assessed in the seronegative (RF and CCP negative) group. The probability of IA in a seronegative patient was 6%. The addition of clinical and radiographic features raised the probability of IA to 30% and, with certain ultrasound features, this rose to 94%.

Conclusions: In seronegative patients with early IA, combining PDUS with routine assessment can have a major impact on the certainty of diagnosis.

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