Feasibility of patient-oriented ultrasound joint selection: Cross-sectional observational study on rheumatoid arthritis

Abstract

Objective: Ultrasonography (US) is a useful tool for evaluating the activity of rheumatoid arthritis (RA) patients. As the systemic evaluation of many joints is time-consuming, a method to evaluate this activity with a smaller number of joints is needed. The aim of this study was to clarify whether the number of joints assessed may be reduced using patient-oriented joint selection.

Methods: A total of 492 RA patients were recruited at Kyoto University Hospital. Bilateral metacarpophalangeal (MCP), (proximal) interphalangeal (PIP/IP), and wrist joints were evaluated by US. Gray scale and power Doppler imaging findings were scored by a 0–3 semi-quantitative method. Clinical assessments were performed by physicians who were blind to US results, and a questionnaire on subjective symptoms was collected from each patient.

Results: The correlation between the US score of all 22 joints (US22) and patient-oriented painful joints (PtUS) or physician-oriented tender and/or swollen joints were moderate (Spearman’s ρ = 0.435) and weak (ρ = 0.383), respectively. These correlations were weaker than that between the total US score of 5 preselected joints (unilateral 2MCP, 3MCP, 2PIP, 3PIP, and the wrist) and US22 (ρ = 0.813). However, when focusing on patients whose painful joints were 5 and more, the correlation between PtUS and US22 was markedly stronger (ρ = 0.757).

Conclusion: Patient-oriented joint selection reflected actual joint inflammation to some extent. However, excessive reductions in the number of joints assessed need to be avoided even if patients do not have arthralgia because of the potential for underestimations.

Keywords:

• Rheumatoid arthritis
• ultrasonography
• disease activity
• self-assessment

Acknowledgments

We would like to thank Mr. Wataru Yamamoto at Kurashiki Sweet Hospital for his excellent support to establish and maintain the KURAMA database.

Conflict of interest

The KURAMA cohort study is supported by grants from Daiichi Sankyo Co., Ltd. This study was conducted as an investigator initiated study. These companies had no role in the design of the study, the collection or analysis of data, the writing of the manuscript, or the decision to submit the manuscript for publication. The Department of Advanced Medicine for Rheumatic Diseases is supported by Nagahama city, Shiga, Japan and four pharmaceutical companies (Mitsubishi Tanabe Pharma Corp., Chugai Pharmaceutical Co., Ltd., Ayumi Pharmaceutical Corp., and UCB Japan Co., Ltd.). M.T. has received research grants and/or speaker fees from AbbVie GK, Asahi Kasei Pharma Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Corp., Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Pfizer Inc., UCB Japan Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corp., Novartis Pharma K.K., and Taisho Pharma Co., Ltd. HI has received a research grant and/or speaker fees from Bristol-Myers, Astellas, and Asahi-Kasei.

Additional information

Funding

This work was supported by Grants-in-Aid from the Japan Agency for Medical Research and Development, from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and from JSPS Kakenhi [grant number 18K12103].