Accuracy of Physical Examination to Detect Synovial and Extra-Synovial Pathologies in Psoriatic Arthritis in Comparison to Ultrasonography
Abstract
:1. Introduction
2. Method
2.1. Patient Selection
2.2. Ultrasonography Protocol
2.3. Statistical Analysis
2.4. Ethical Approval
3. Results
3.1. Patient Characteristics
3.2. Physical Examination Findings
3.3. Ultrasonography Findings
3.4. Agreement of Physical Examination and Ultrasonography
3.5. Distribution of Ultrasonography Findings According to Tenderness
4. Discussion
Author Contributions
Funding
Conflicts of Interest
Abbreviations
DIPj | Distal interphalangeal joint |
EE | Extensor enthesis |
ET | Extensor tendon |
FF | Flexor enthesis |
FT | Flexor tendon |
GS | Grey scale |
MCPj | Metacarpophalangeal joint |
MH | Metacarpal head |
MP | Middle phalanx |
PABAK | Prevalence adjusted and bias-adjusted kappa |
PIPj | Proximal interphalangeal joint |
PP | Proximal phalanx |
US | Ultrasonography |
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Physical Examination of the Joints and Entheses | ||||
---|---|---|---|---|
Tender | Swollen | Tender and Swollen | Tender or Swollen | |
MCPj, n (%) | 122 (52.5) | 13 (5.6) | 12 (5.2) | 123 (53) |
PIPj, n (%) | 100 (43.1) | 79 (34) | 61 (26.3) | 117 (50.4) |
DIPj, n (%) | 97 (42) | 19 (8.2) | 13 (5.6) | 100 (43) |
Extensor Entheses, n (%) | 58 (25) | |||
Flexor Entheses, n (%) | 46 (20) | |||
Physical examination of Tendons | ||||
Tender against resistance | Tender against palpation | Swollen | Any finding | |
Extensor, n (%) | 34 (14.7) | 48 (20.7) | 13 (5.6) | 64 (27.6) |
Flexor, n (%) | 31 (13.4) | 47 (20.3) | 21 (9) | 68 (29) |
Articular US Findings | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Grey scale positivity | Power Doppler positivity | ||||||||||
Any | ≥2 | Any | ≥2 | ||||||||
MCPj, n (%) | 89 (38.4) | 24 (10.3) | 15 (6.5) | 10 (4.3) | |||||||
PIPj, n (%) | 35 (15) | 15 (6.5) | 16 (7) | 7 (3) | |||||||
DIPj, n (%) | 3 (1.3) | 1 (0.4) | 2 (0.9) | 0 | |||||||
Tendon US Findings | |||||||||||
Hypo-echogenicity | Thickening | Doppler | Paratenonitis | Tenosynovitis Gray Scale | Tenosynovitis Doppler | ||||||
Extensor | 19 (8) | 24 (10) | 13 (5.6) | 3 (1.3) | |||||||
Flexor | 18 (7.8) | 27 (11.6) | 14 (6) | 12 (5) | 6 (2.6) | ||||||
Entheseal US Findings | |||||||||||
Hypo-echogenicity | Thickening | Doppler | |||||||||
Extensor tendon Middle phalanx insertion | 23 (10) | 39 (16.8) | 3 (1.3) | ||||||||
Extensor tendon Distal phalanx insertion | 8 (3.4) | 31 (13.4) | 7 (3) | ||||||||
Flexor tendon Distal phalanx insertion | 6 (2.6) | 9 (4) | 3 (1.3) |
Power Doppler | Kappa/PABAK | Grey Scale | Kappa/PABAK | ||||||
---|---|---|---|---|---|---|---|---|---|
Absent | Present | Absent | Present | ||||||
MCPj | Tender joints, n | Absent | 108 | 2 | 0.084/0.043 | 73 | 37 | 0.089/0.077 | |
Present | 109 | 13 | 70 | 52 | |||||
Swollen joints, n | Absent | 208 | 11 | 0.240/0.827 | 139 | 80 | 0.087/0.275 | ||
Present | 9 | 4 | 4 | 9 | |||||
Tender AND Swollen joints, n | Absent | 208 | 12 | 0.175/0.819 | 139 | 81 | 0.074/0.267 | ||
Present | 9 | 3 | 4 | 8 | |||||
Tender OR Swollen joints, n | Absent | 108 | 1 | 0.099/0.051 | 73 | 36 | 0.098/0.086 | ||
Present | 109 | 14 | 70 | 53 | |||||
PIPj | Tender joints, n | Absent | 128 | 4 | 0.099/0.206 | 123 | 9 | 0.208/0.284 | |
Present | 88 | 12 | 74 | 26 | |||||
Swollen joints, n | Absent | 152 | 1 | 0.227/0.439 | 144 | 9 | 0.312/0.465 | ||
Present | 64 | 15 | 53 | 26 | |||||
Tender AND Swollen joints, n | Absent | 167 | 4 | 0.227/0.543 | 158 | 13 | 0.330/0.551 | ||
Present | 49 | 12 | 39 | 22 | |||||
Tender OR Swollen joints, n | Absent | 114 | 1 | 0.119/0.112 | 109 | 6 | 0.195/0.189 | ||
Present | 102 | 15 | 88 | 29 | |||||
DIPj | Tender joints, n | Absent | 134 | 1 | 0.003/0.163 | 133 | 2 | −0.005/0.155 | |
Present | 96 | 1 | 96 | 1 | |||||
Swollen joints, n | Absent | 211 | 2 | −0.016/0.819 | 210 | 3 | −0.023/0.810 | ||
Present | 19 | 0 | 19 | 0 | |||||
Tender AND Swollen joints, n | Absent | 217 | 2 | −0.015/0.870 | 216 | 3 | −0.021/0.862 | ||
Present | 13 | 0 | 13 | 0 | |||||
Tender OR Swollen joints, n | Absent | 131 | 1 | 0.003/0.137 | 130 | 2 | −0.006/0.129 | ||
Present | 99 | 1 | 99 | 1 | |||||
Tenderness on PE | Any inflammation on US within the enthesis, n | Kappa/PABAK | |||||||
Absent | Present | ||||||||
EE * | Absent | 149 | 25 | −0.027/0.344 | |||||
Present | 51 | 7 | |||||||
FE | Absent | 179 | 7 | 0.039/0.569 | |||||
Present | 43 | 3 | |||||||
Tenderness on PE | Any inflammation on US within the tendons, n | Kappa/PABAK | |||||||
Absent | Present | ||||||||
ET | Absent | 158 | 10 | 0.123/0.448 | |||||
Present | 54 | 10 | |||||||
FT | Absent | 151 | 13 | 0.171/0.431 | |||||
Present | 53 | 15 |
US Findings | Tenderness of Digits *, n | ||
---|---|---|---|
Present (n = 178) n (%) | Absent (n = 54) n (%) | ||
MCPj GS synovitis | Present | 73 (41) | 16 (30) |
Absent | 105 (59) | 38 (70) | |
MCPj Power Doppler | Present | 13 (7.3) | 2 (3.7) |
Absent | 165 (93) | 52 (96.3) | |
PIPj GS synovitis | Present | 32 (18) | 3 (5.5) |
Absent | 146 (82) | 51 (94.5) | |
PIPj Power Doppler | Present | 15 (8.4) | 1 (1.8) |
Absent | 163 (91.6) | 53 (98.2) | |
DIPj GS synovitis | Present | 3 (1.7) | 0 |
Absent | 175 (98.3) | 54 (100) | |
DIPj Power Doppler | Present | 2 (1.1) | 0 |
Absent | 176 (99) | 54 (100) | |
Extensor Tendon | Present | 16 (9) | 4 (7.5) |
Absent | 162 (91) | 50 (92.5) | |
Flexor Tendon | Present | 24 (13.4) | 4 (7.5) |
Absent | 154 (86.6) | 50 (92.5) | |
Extensor tendon Middle phalanx insertion | Present | 32 (18) | 9 (16.6) |
Absent | 146 (82) | 45 (83.4) | |
Extensor tendon Distal phalanx insertion | Present | 30 (17) | 2 (3.7) |
Absent | 148 (83) | 52 (96.3) | |
Flexor tendon Distal phalanx insertion | Present | 10 (5.6) | 0 |
Absent | 168 (94.4) | 54 (100) |
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Gazel, U.; Solmaz, D.; Ayan, G.; Ivory, C.; Karsh, J.; Aydin, S.Z. Accuracy of Physical Examination to Detect Synovial and Extra-Synovial Pathologies in Psoriatic Arthritis in Comparison to Ultrasonography. J. Clin. Med. 2020, 9, 2929. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9092929
Gazel U, Solmaz D, Ayan G, Ivory C, Karsh J, Aydin SZ. Accuracy of Physical Examination to Detect Synovial and Extra-Synovial Pathologies in Psoriatic Arthritis in Comparison to Ultrasonography. Journal of Clinical Medicine. 2020; 9(9):2929. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9092929
Chicago/Turabian StyleGazel, Ummugulsum, Dilek Solmaz, Gizem Ayan, Catherine Ivory, Jacob Karsh, and Sibel Zehra Aydin. 2020. "Accuracy of Physical Examination to Detect Synovial and Extra-Synovial Pathologies in Psoriatic Arthritis in Comparison to Ultrasonography" Journal of Clinical Medicine 9, no. 9: 2929. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9092929