The diagnostic accuracy of the squeeze test to identify arthritis: a cross-sectional cohort study. Issue 10 (24th April 2015)

• Record Type: Journal Article
• Authors: van den Bosch, W B; Mangnus, L; Reijnierse, M; Huizinga, T W J; van der Helm-van Mil, A H M
• Is Part Of: Annals of the rheumatic diseases. Volume 74:Issue 10(2015)
• Page Start: 1886
• Page End: 1889
• Publication Date: 2015-04-24
• Subjects: Rheumatoid Arthritis -- Early Rheumatoid Arthritis -- Magnetic Resonance Imaging; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2014-207202
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objectives: 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.