title: Concordance of Patient-Reported Joint Symptoms, Physician-Examined Arthritic Signs, and Ultrasound-Detected Synovitis in Rheumatoid Arthritis.
abstract: Ultrasonography has been prevalently used as a valid and objective modality for joint examination in patients with rheumatoid arthritis (RA). This study aimed to examine and compare the concordance between ultrasound, clinical assessment, and patient-reported assessment of joint synovitis in RA.
  
  
  
  Fifty patients with RA (84% female, median age 69 years, median disease duration 31 months, and median Disease Activity Score in 28 joints 3.8) completed the self-evaluation of joint symptoms, including pain and considerable stiffness in the (proximal) interphalangeal, metacarpophalangeal, wrist, elbow, shoulder, knee, and ankle joints. These joints were also examined by a physician in order to assess the presence of tenderness or swelling; the presence of imaging synovitis was assessed by ultrasonography.
  
  
  
  In a total of 1,492 evaluated joints, symptoms (pain and stiffness), tenderness, and swelling were noted in 288 (19.3%), 182 (12.2%), and 220 (14.7%) joints, respectively, while ultrasound indicated synovitis in 317 (21.2%) joints. Overall concordance with ultrasound findings was lowest for joint tenderness (κ = 0.30), followed by symptoms (κ = 0.39), and by swelling (κ = 0.43), irrespective of the evaluated joint, except for the elbow. Moreover, the percentages of inflamed joints detected only on the basis of symptoms, tenderness, or swelling were 18.6%, 2.2%, and 8.5%, respectively, of all joints with signs of synovitis on ultrasonography.
  
  
  
  Joint swelling showed the best concordance with ultrasonography, followed by patient-reported joint symptoms, and joint tenderness. Joint symptoms, rather than tenderness evaluation, may be a better clinical indicator of synovitis in RA patients.
authors: Toho University, Tokyo, Japan.
authors: Ayako
authors: A
authors: Hirata
authors: Toho University, Tokyo, Japan.
authors: Takehisa
authors: T
authors: Ogura
authors: Toho University, Tokyo, Japan.
authors: Norihide
authors: N
authors: Hayashi
authors: Toho University, Tokyo, Japan.
authors: Sayaka
authors: S
authors: Takenaka
authors: Toho University, Tokyo, Japan.
authors: Hideki
authors: H
authors: Ito
authors: Toho University, Tokyo, Japan.
authors: Kennosuke
authors: K
authors: Mizushina
authors: Toho University, Tokyo, Japan.
authors: Yuki
authors: Y
authors: Fujisawa
authors: Toho University, Tokyo, Japan.
authors: Naoko
authors: N
authors: Yamashita
authors: Toho University, Tokyo, Japan.
authors: Sumie
authors: S
authors: Nakahashi
authors: Toho University, Tokyo, Japan.
authors: Munetsugu
authors: M
authors: Imamura
authors: Toho University, Tokyo, Japan.
authors: Rie
authors: R
authors: Kujime
authors: Toho University, Tokyo, Japan.
authors: Hideto
authors: H
authors: Kameda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000453:epidemiology; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D012189:Retrospective Studies; D016037:Single-Blind Method; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018608:Ultrasonography, Doppler / Q000592:standards*