title: Factors influencing concordance between clinical and ultrasound findings in rheumatoid arthritis.
abstract: OBJECTIVE
  Clinical joint examination (CJE) is less time-consuming than ultrasound (US) in rheumatoid arthritis (RA). Low concordance between CJE and US would indicate that the 2 tests provide different types of information. Knowledge of factors associated with CJE/US concordance would help to select patients and joints for US. Our objective was to identify factors associated with CJE/US concordance.
  
  
  METHODS
  Seventy-six patients with RA requiring tumor necrosis factor-α (TNF-α) antagonist therapy were included in a prospective, multicenter cohort. In each patient, 38 joints were evaluated. Synovitis was scored using CJE, B-mode US (B-US), and power Doppler US (PDUS). Joints whose kappa coefficient (κ) for agreement CJE/US was < 0.1 were considered discordant. Multivariate analysis was performed to identify factors independently associated with CJE/US concordance, defined as factors yielding p < 0.05 and OR > 2.
  
  
  RESULTS
  Concordance before TNF-α antagonist therapy varied across joints for CJE/US (κ = -0.08 to 0.51) and B-US/PDUS (κ = 0.30 to 0.67). CJE/US concordance was low at the metatarsophalangeal joints and shoulders (κ < 0.1). Before TNF-α antagonist therapy, a low 28-joint Disease Activity Score (DAS28) was associated with good CJE/B-US concordance, and no factors were associated with CJE/PDUS concordance. After TNF-α antagonist therapy, only the joint site was associated with CJE/B-US concordance; joint site and short disease duration were associated with CJE/PDUS concordance.
  
  
  CONCLUSIONS
  Concordance between CJE and US is poor overall. US adds information to CJE, most notably at the metatarsophalangeal joints and shoulders. Usefulness is decreased for B-US when DAS28 is low and for PDUS when disease duration is short.
authors: Rheumatology, Centre Hospitalier Universitaire (CHU) Brest, Brest, France.
authors: Marion
authors: M
authors: Le Boedec
authors: Sandrine
authors: S
authors: Jousse-Joulin
authors: Jean-François
authors: JF
authors: Ferlet
authors: Thierry
authors: T
authors: Marhadour
authors: Gérard
authors: G
authors: Chales
authors: Laurent
authors: L
authors: Grange
authors: Cécile
authors: C
authors: Hacquard-Bouder
authors: Damien
authors: D
authors: Loeuille
authors: Jérémie
authors: J
authors: Sellam
authors: Jean-David
authors: JD
authors: Albert
authors: Jacques
authors: J
authors: Bentin
authors: Isabelle
authors: I
authors: Chary-Valckenaere
authors: Maria-Antonietta
authors: MA
authors: D'Agostino
authors: Fabien
authors: F
authors: Etchepare
authors: Philippe
authors: P
authors: Gaudin
authors: Christophe
authors: C
authors: Hudry
authors: Maxime
authors: M
authors: Dougados
authors: Alain
authors: A
authors: Saraux
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D013585:Synovitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014463:Ultrasonography
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha