title: Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination.
abstract: Signs of inflammation and destruction in the finger joints are the principal features of rheumatoid arthritis (RA). There are few studies assessing the sensitivity and specificity of ultrasonography in detecting these signs. The objective of the present study was to investigate whether ultrasonography can provide information on signs of inflammation and destruction in RA finger joints that are not available with conventional radiography and clinical examination, and comparable to the information provided by magnetic resonance imaging (MRI). The second to fifth metacarpophalangeal and proximal interphalangeal joints of 40 RA patients and 20 control persons were assessed with ultrasonography, clinical examination, radiography and MRI. With MRI as the reference method, the sensitivity, specificity and accuracy of ultrasonography in detecting bone erosions in the finger joints were 0.59, 0.98 and 0.96, respectively; they were 0.42, 0.99 and 0.95 for radiography. The sensitivity, specificity and accuracy of ultrasonography, with signs of inflammation on T1-weighted MRI sequences as the reference method, were 0.70, 0.78 and 0.76, respectively; they were 0.40, 0.85 and 0.72 for the clinical examination. With MRI as the reference method, ultrasonography had higher sensitivity and accuracy in detecting signs of inflammation and destruction in RA finger joints than did clinical and radiographic examinations, without loss of specificity. This study shows that ultrasonography has the potential to improve assessment of patients with RA.
authors.affiliation: Department of Rheumatology, University of Copenhagen Hvidovre Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark. marcin@dadlnet.dk
authors.forename: Marcin
authors.initials: M
authors.lastname: Szkudlarek
authors.forename: Mette
authors.initials: M
authors.lastname: Klarlund
authors.forename: Eva
authors.initials: E
authors.lastname: Narvestad
authors.forename: Michel
authors.initials: M
authors.lastname: Court-Payen
authors.forename: Charlotte
authors.initials: C
authors.lastname: Strandberg
authors.forename: Karl E
authors.initials: KE
authors.lastname: Jensen
authors.forename: Henrik S
authors.initials: HS
authors.lastname: Thomsen
authors.forename: Mikkel
authors.initials: M
authors.lastname: Østergaard
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D001175:Arthrography / Q000592:standards; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D010808:Physical Examination / Q000592:standards; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000592:standards*