title: The relationship of patient-reported joints with active synovitis detected by power Doppler ultrasonography in rheumatoid arthritis.
abstract: OBJECTIVE
  This paper aims to evaluate the relationship of patient-reported tender and swollen joints with active inflammation as detected by power Doppler (PDUS) and whether this relationship is affected by significant joint damage.
  
  
  METHODS
  Fifty rheumatoid arthritis patients self-assessed 28 tender and swollen joints and were followed by PDUS assessment. Relationship of tender and swollen joints with active synovitis (PDUS 'gold standard') was assessed at the joint level by: a) percentage agreement at each PDUS semiquantitative grade (grade 1 to 3), b) positive likelihood ratio (LR) of agreement with PDUS, and c) LR of agreement with PDUS according to radiographic damage (significant erosive disease vs. non-erosive disease). Correlation of tender and swollen joint counts with disease activity markers was analysed by Spearman's. Sensitivity analyses examined the influence of disease activity or global pain on level of agreement at the joint level.
  
  
  RESULTS
  Of joints with significant active inflammation (e.g. grade 3 PDUS), patients identified 75% as tender and 63% as swollen. Swollen joints showed strong association at the joint level with active synovitis when there was no significant radiographic damage (LR 2.54, 95%CI 1.93-3.34), but with no significant radiographic damage (LR 1.32, 95%CI 0.75-2.32). Swollen joint counts were statistically correlated with PDUS-DAS28 and CRP, but not PDUS score. Sensitivity analysis showed better agreement of tender and swollen joints with active synovitis when DAS28 was ≤ 3.2 and when patient global pain was <50mm on visual analogue scale.
  
  
  CONCLUSIONS
  The relationship between patient-reported joints and active synovitis is stronger in the setting of low disease activity without erosive disease, affected also by degree of reported global pain. Further longitudinal studies of patient-reported joints are needed.
authors.affiliation: Paris-Descartes University, Medicine Faculty, Rheumatology B, Paris, France. peter_cheung@nuhs.edu.sg
authors.forename: Peter P
authors.initials: PP
authors.lastname: Cheung
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Adeline
authors.initials: A
authors.lastname: Ruyssen-Witrand
authors.forename: Catherine
authors.initials: C
authors.lastname: Le Bourlout
authors.forename: Maryse
authors.initials: M
authors.lastname: Mézières
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D001175:Arthrography / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D057566:Self Report / Q000592:standards*; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler / Q000379:methods / Q000592:standards*