The diagnostic accuracy of the squeeze test to identify arthritis: a cross-sectional cohort study.
OBJECTIVE
In daily practice, the squeeze test is used to screen for arthritis in metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints. This cross-sectional cohort study determined the diagnostic accuracy of this test.


METHODS
Patients referred with arthralgia of recent onset that had either a clinical suspicion for progression to arthritis or clinically apparent arthritis were studied. The main outcome was swelling at physical examination of ≥1 MCP or MTP joint. Joint inflammation detected at extremity MRI was the secondary outcome.


RESULTS
Both at MCP and MTP joints, a positive squeeze test associated with swollen joints (p<0.005). The sensitivity of the test at the MCP joints was 53%, specificity 82%, positive likelihood ratio (LR+) 3.0, negative likelihood ratio (LR-) 0.6 and area under the receiver operator characteristic curve (AUC) 0.68. At the MTP joints, the sensitivity was 54%, specificity 74%, LR+ 2.1, LR- 0.6 and AUC 0.64. With MRI-detected inflammation as outcome, the sensitivity and specificity were 39% and 86% and 31% and 69% for the test at the MCP and MTP joints, respectively.


CONCLUSIONS
A positive squeeze test is associated with local joint inflammation but the sensitivity is low, indicating a high percentage of swollen joints with a negative squeeze test. When the test is used on its own, it is insufficient to detect early arthritis.
Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.
W B
WB
van den Bosch
Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.
L
L
Mangnus
Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
M
M
Reijnierse
Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.
T W J
TW
Huizinga
Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.
A H M
AH
van der Helm-van Mil
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004487:Edema / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008662:Metacarpophalangeal Joint / Q000503:physiopathology*; D008683:Metatarsophalangeal Joint / Q000503:physiopathology*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010808:Physical Examination / Q000379:methods*; D011312:Pressure; D012680:Sensitivity and Specificity
Early Rheumatoid Arthritis; Magnetic Resonance Imaging; Rheumatoid Arthritis