A diagnostic algorithm for persistence of very early inflammatory arthritis: the utility of power Doppler ultrasound when added to conventional assessment tools. Issue 2 (8th April 2009)

• Record Type: Journal Article
• Authors: Freeston, J E; Wakefield, R J; Conaghan, P G; Hensor, E M A; Stewart, S P; Emery, P
• Is Part Of: Annals of the rheumatic diseases. Volume 69:Issue 2(2010)
• Page Start: 417
• Page End: 419
• Publication Date: 2009-04-08
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/ard.2008.106658
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objectives: The aim of this study was to assess the value of power Doppler ultrasound (PDUS) in combination with routine management in a cohort of patients with very early inflammatory arthritis (IA). Methods: 50 patients with ⩽12 weeks of inflammatory symptoms with or without signs had clinical, laboratory and imaging assessments. Diagnosis was recorded at 12 months. Assuming a 15% pre-test probability of IA, post-test probabilities for various assessments were calculated and used to develop a diagnostic algorithm. Results: All patients positive for rheumatoid factor (RF) and/or cyclic citrullinated peptide (CCP) developed persistent IA, so the added value of PDUS was assessed in the seronegative (RF and CCP negative) group. The probability of IA in a seronegative patient was 6%. The addition of clinical and radiographic features raised the probability of IA to 30% and, with certain ultrasound features, this rose to 94%. Conclusions: In seronegative patients with early IA, combining PDUS with routine assessment can have a major impact on the certainty of diagnosis.