A prospective study comparing the clinical examination of peripheral joints with radionuclide scintigraphy in patients with rheumatoid arthritis.
Fifteen patients with classical rheumatoid arthritis were evaluated prospectively on 3 occasions to determine if any additional data could be obtained by joint scintigraphy which was not found by physical examination. Clinical and scan examinations were performed simultaneously and the scans were interpreted qualitatively by a radiologist without knowledge of the clinical findings. Simultaneous evaluations of 86 shoulder, elbow, knee, ankle, 84 wrist, 420 MCP and PIP, and 430 MTP joints were recorded. Concordance was noted in 67% of the evaluations and this was significant for the MCP, PIP, elbow, shoulder, knee, MTP, ankle, but not wrist joints. In 10% of instances the clinical examination was positive when the joint scan was negative. On average, the scan was positive 23% of the time (range 5-44%), when the clinical findings were normal. However, most of these scan abnormalities were due to minimal radionuclide uptake. The scan was most useful in the detection of MTP and ankle abnormalities which had been scored clinically negative, suggesting that greater attention be devoted to the clinical examination of the RA foot by the rheumatologist.
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001175:Arthrography; D003951:Diagnostic Errors; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging