An ultrasound negative for subclinical synovitis in arthralgia patients: is it helpful in identifying those not developing arthritis?: A longitudinal study in four arthralgia cohorts. (13th April 2022)

• Record Type: Journal Article
• Authors: Rogier, Cleo; Frazzei, Giulia; Kortekaas, Marion C; Verstappen, Marloes; Ohrndorf, Sarah; van Mulligen, Elise; van Vollenhoven, Ronald F; van Schaardenburg, Dirkjan; de Jong, Pascal H P; van der Helm-van Mil, Annette H M
• Is Part Of: Rheumatology. Volume 61:Number 12(2022)
• Page Start: 4892
• Page End: 4897
• Publication Date: 2022-04-13
• Subjects: arthralgia -- inflammatory arthritis -- ultrasonography -- outcome assessment healthcare -- power Doppler -- RA; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keac239
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective: To investigate the negative predictive value (NPV) of musculoskeletal US (MSUS) in arthralgia patients at risk for developing inflammatory arthritis. Methods: An MSUS examination of hands and feet was performed in arthralgia patients at risk for inflammatory arthritis in four independent cohorts. Patients were followed for one-year on the development of inflammatory arthritis. Subclinical synovitis was defined as greyscale ≥2 and/or power Doppler ≥1. NPVs were determined and compared with the prior risks of not developing inflammatory arthritis. Outcomes were pooled using meta-analyses and meta-regression analyses. In sensitivity analyses, MSUS imaging of tender joints only (rather than the full US protocol) was analysed and ACPA stratification applied. Results: After 1 year 78, 82, 77 and 72% of patients in the four cohorts did not develop inflammatory arthritis. The NPV of a negative US was 86, 85, 82 and 90%, respectively. The meta-analysis showed a pooled non-inflammatory arthritis prevalence of 79% (95% CI 75%, 83%) and a pooled NPV of 86% (95% CI 81, 89%). Imaging tender joints only (as generally done in clinical practice) and ACPA stratification showed similar results. Conclusion: A negative US result in arthralgia has a high NPV for not developing inflammatory arthritis, which is mainly due to the high a priori risk of not developing inflammatory arthritis. The added value of a negative US (<10% increase) was limited.