RESEARCH - Joint swelling better than joint tenderness for detecting RA synovitis

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Joint swelling better than joint tenderness for detecting RA synovitis

Rheumawire

November 21, 2005

Janis

San Diego, CA- A study comparing the reliability of physical exam with

magnetic resonance imaging (MRI) for detecting synovitis in rheumatoid

arthritis (RA) or psoriatic arthritis (PsA) found that visual inspection may

be better than the usual two-finger palpation in RA and that better exam

methods are needed for PsA synovitis, according to Dr Millicent A Stone

(University of Toronto, ON).

In data presented at the 2005 ACR/ARHP Annual Scientific Meeting, Stone

said, " Joint tenderness is not as reliable or accurate as joint swelling in

the assessment of synovitis. Visual inspection alone may be the simplest and

most reliable technique for assessing synovitis in RA. "

Clinical exam more accurate in RA than in PsA

" Rheumatologists base many of their clinical decisions regarding the

management of inflammatory joint diseases such as rheumatoid arthritis and

psoriatic arthritis on joint counts, but how accurate or reliable are

clinical-exam skills? Joint swelling has been shown to be a prognostic

marker for radiographic progression in RA, but tender-joint counts correlate

less well with radiographic progression in RA. Early detection of synovitis

and aggressive treatment has been shown to prevent long-term disability. The

ability to detect synovitis by clinical examination may also differ with

different forms of arthritis, such as PsA, where the joint swelling may be

predominantly extrasynovial, " Stone said.

The objective of this study was to determine the reliability of physical

examination of the metacarpophalangeal joints (MCPJs) for detecting

inflammatory synovitis compared with MRI. Five independent examiners

assessed the second to fifth MCPJs in both hands of five patients with RA

and five with PsA. Each patient was examined for joint-line swelling using

the two-finger and four-finger techniques and by visual estimation for

swelling. Patients were also assessed for tenderness by stress pain and

joint-line tenderness.

The researchers reported that for RA, there was a strong positive

relationship between two-finger assessments and MRI synovitis and erosion

scores, and an even stronger relationship was present between four-finger

assessments and synovitis and erosion scores. For PsA patients, there was no

correlation between joint examination and MRI measurements. Visual

estimation of swelling correlated well with MRI synovitis in RA but not with

PsA. Tender-joint count was not significantly associated with MRI in either

RA or PsA.

" Joint swelling, but not joint tenderness or stress pain, correlated

significantly with synovitis and joint erosion. The four-finger palpation

technique for evaluation of MCPJ swelling was superior to the standard

two-finger technique for both disorders, " Stone reports. " Palpation and

visual inspection of MCPJs of RA patients is extremely reliable at

determining synovitis. Palpation and visual inspection of MCPJs of PsA

patients was unreliable. Assessment of joint swelling using the four-finger

technique may further improve the sensitivity of detection. "

This study was supported by Centocor.

Source

1. Stone MA, White L, Gladman D, et al. Reliability of

physical examination in inflammatory arthritis: ROPE study. 2005 ACR/ARHP

Annual Scientific Meeting; November 12-17. 2005; San Diego, CA. Abstract

224.

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Mayo Clinic in Rochester

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s Hopkins Medicine

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