title: Predictive grade of ultrasound synovitis for diagnosing rheumatoid arthritis in clinical practice and the possible difference between patients with and without seropositivity.
abstract: OBJECTIVE
  To determine the degree of contribution and the contributing factors of ultrasound in the diagnosis of rheumatoid arthritis (RA) in daily clinical practice and the predictive differences depending on seropositivity.
  
  
  METHODS
  We included 122 patients who presented with the main complaint of finger and/or wrist joint pain but for whom no definite diagnosis was reached or treatment strategy was provided. Ultrasound was performed on at least 22 joints (both wrist joints, proximal interphalangeal joint, and metacarpophalangeal joints), and patients were followed for ≥6 months. Factors contributing to RA diagnosis were determined and compared between seropositive and seronegative RA patients.
  
  
  RESULTS
  RA was diagnosed in 52 of 122 patients, in whom the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria (odds ratio [OR] = 4.74, P = 0.01) and gray scale (GS) grade of 3 (OR = 3.64, P = 0.04) for ≥ 1 joint were the contributing factors. In seropositive RA, the ACR/EULAR criteria (OR = 15.53, P < 0.001) and power Doppler (PD) ≥ 2 for ≥ 1 joint (OR = 10.48, P = 0.0048) were the contributing factors. In seronegative RA, PD ≥ 1 for ≥ 1 joint contributed the most (OR = 20.00, P = 0.0044), but the ACR/EULAR criteria did not contribute to RA diagnosis (P = 0.57).
  
  
  CONCLUSIONS
  Ultrasound findings contributed to RA diagnosis in clinical practice. The contributing factors are different in the presence or absence of seropositivity, and ultrasound complementation was particularly useful in seronegative RA patients.
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minowa
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Ogasawara
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Murayama
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Misa
authors.initials: M
authors.lastname: Gorai
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nemoto
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Matsuki
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Nagachika
authors.initials: N
authors.lastname: Sugisaki
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ando
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kon
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Kurisu
authors.initials: K
authors.lastname: Tada
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaji
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.affiliation: a Department of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Tokyo , Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012217:Rheumatoid Factor / Q000097:blood; D012219:Rheumatology; D013585:Synovitis / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014955:Wrist Joint / Q000000981:diagnostic imaging*
chemical_list: D002097:C-Reactive Protein; D012217:Rheumatoid Factor
keywords: Predictive factor; Rheumatoid arthritis; Ultrasound