Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-naïve early psoriatic arthritis

Sayam R Dubash; Oras A Alabas; Xabier Michelena; Leticia Garcia-Montoya; Gabriele De Marco; Mira Merashli; Richard J Wakefield; Paul Emery; Dennis McGonagle; Ai Lyn Tan; Helena Marzo-Ortega

doi:10.1093/rap/rkab086

Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-naïve early psoriatic arthritis

Sayam R Dubash, Oras A Alabas, Xabier Michelena, Leticia Garcia-Montoya, Gabriele De Marco, Mira Merashli, Richard J Wakefield, Paul Emery, Dennis McGonagle, Ai Lyn Tan, Helena Marzo-Ortega

Division of Musculoskeletal & Dermatological Sciences (L5)

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Abstract

Objective: To evaluate the relationship between clinical examination/US synovitis in DMARD-naïve early PsA. Methods: Eligible patients underwent matched clinical/US 44-joint assessment for tender and/or swollen joints (TJ/SJ) and US synovitis [grey scale (GS) ≥ 2 or power Doppler (PD) ≥ 1]. Statistical agreement between TJ/SJ, GS ≥ 2 and PD ≥ 1 was calculated by prevalence-adjusted and bias-adjusted κ (PABAK). To derive probabilities of GS ≥ 2/PD ≥ 1, mixed-effects logistic regression-modelled odds of US synovitis in TJ/SJ were conducted. Results: In 155 patients, 5616 joints underwent clinical/US examination. Of these joints, 1039 of 5616 (18.5%) were tender, 550 of 5616 (9.8%) were swollen, 1144 of 5616 (20.4%) had GS ≥ 2, and 292 of 5616 (5.2%) had PD ≥ 1. GS ≥ 2 was most prevalent in concomitantly tender and swollen joints [205 of 462 (44%)], followed by swollen non-tender joints [32 of 88 (36.4%)], tender non-swollen joints [148 of 577 (25.7%)] and non-tender non-swollen joints (subclinical synovitis) [759 of 4489 (16.9%)]. Agreement between SJ/PD ≥ 1 was high at the individual joint level (82.6-96.3%, PABAK 0.65-0.93) and for total joints combined (89.9%, PABAK 0.80). SJ/GS ≥ 2 agreement was greater than between TJ/GS ≥ 2 [73.5-92.6% vs 51.0-87.4% (PABAK 0.47-0.85 vs PABAK 0.35-0.75), respectively]. Swelling was independently associated with higher odds of GS ≥ 2 [odds ratio (OR) (95% CI); 4.37 (2.62, 7.29); P < 0.001] but not tenderness [OR = 1.33 (0.87, 2.06); P = 0.192]. Swelling [OR = 8.78 (3.92, 19.66); P < 0.001] or tenderness [OR = 3.38 (1.53, 7.50); P = 0.003] was independently associated with higher odds of PD ≥ 1. Conclusion: Synovitis (GS ≥ 2 and/or PD ≥ 1) was more likely in swollen joints than in tender joints in DMARD-naïve, early PsA. Agreement indicated that swollen joints were the better proxy for synovitis, adding to greater understanding between clinical and US assessments.

Original language	English
Article number	rkab086
Pages (from-to)	1-12
Number of pages	12
Journal	Rheumatology Advances in Practice
Volume	5
Issue number	3
DOIs	https://doi.org/10.1093/rap/rkab086
Publication status	Published - 15 Nov 2021

Keywords

PsA
US
clinical examination
disease activity
physical examination
spondyloarthritis
spondyloarthropathies
synovitis

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Dubash, S. R., Alabas, O. A., Michelena, X., Garcia-Montoya, L., De Marco, G., Merashli, M., Wakefield, R. J., Emery, P., McGonagle, D., Tan, A. L., & Marzo-Ortega, H. (2021). Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-naïve early psoriatic arthritis. Rheumatology Advances in Practice, 5(3), 1-12. Article rkab086. https://doi.org/10.1093/rap/rkab086

@article{949a3501735b44009d7968a77ba8f8f0,

title = "Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-na{\"i}ve early psoriatic arthritis",

abstract = "Objective: To evaluate the relationship between clinical examination/US synovitis in DMARD-na{\"i}ve early PsA. Methods: Eligible patients underwent matched clinical/US 44-joint assessment for tender and/or swollen joints (TJ/SJ) and US synovitis [grey scale (GS) ≥ 2 or power Doppler (PD) ≥ 1]. Statistical agreement between TJ/SJ, GS ≥ 2 and PD ≥ 1 was calculated by prevalence-adjusted and bias-adjusted κ (PABAK). To derive probabilities of GS ≥ 2/PD ≥ 1, mixed-effects logistic regression-modelled odds of US synovitis in TJ/SJ were conducted. Results: In 155 patients, 5616 joints underwent clinical/US examination. Of these joints, 1039 of 5616 (18.5%) were tender, 550 of 5616 (9.8%) were swollen, 1144 of 5616 (20.4%) had GS ≥ 2, and 292 of 5616 (5.2%) had PD ≥ 1. GS ≥ 2 was most prevalent in concomitantly tender and swollen joints [205 of 462 (44%)], followed by swollen non-tender joints [32 of 88 (36.4%)], tender non-swollen joints [148 of 577 (25.7%)] and non-tender non-swollen joints (subclinical synovitis) [759 of 4489 (16.9%)]. Agreement between SJ/PD ≥ 1 was high at the individual joint level (82.6-96.3%, PABAK 0.65-0.93) and for total joints combined (89.9%, PABAK 0.80). SJ/GS ≥ 2 agreement was greater than between TJ/GS ≥ 2 [73.5-92.6% vs 51.0-87.4% (PABAK 0.47-0.85 vs PABAK 0.35-0.75), respectively]. Swelling was independently associated with higher odds of GS ≥ 2 [odds ratio (OR) (95% CI); 4.37 (2.62, 7.29); P < 0.001] but not tenderness [OR = 1.33 (0.87, 2.06); P = 0.192]. Swelling [OR = 8.78 (3.92, 19.66); P < 0.001] or tenderness [OR = 3.38 (1.53, 7.50); P = 0.003] was independently associated with higher odds of PD ≥ 1. Conclusion: Synovitis (GS ≥ 2 and/or PD ≥ 1) was more likely in swollen joints than in tender joints in DMARD-na{\"i}ve, early PsA. Agreement indicated that swollen joints were the better proxy for synovitis, adding to greater understanding between clinical and US assessments.",

keywords = "PsA, US, clinical examination, disease activity, physical examination, spondyloarthritis, spondyloarthropathies, synovitis",

author = "Dubash, {Sayam R} and Alabas, {Oras A} and Xabier Michelena and Leticia Garcia-Montoya and {De Marco}, Gabriele and Mira Merashli and Wakefield, {Richard J} and Paul Emery and Dennis McGonagle and Tan, {Ai Lyn} and Helena Marzo-Ortega",

note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.",

year = "2021",

month = nov,

day = "15",

doi = "10.1093/rap/rkab086",

language = "English",

volume = "5",

pages = "1--12",

journal = "Rheumatology Advances in Practice",

issn = "2514-1775",

publisher = "Oxford University Press",

number = "3",

}

Dubash, SR, Alabas, OA, Michelena, X, Garcia-Montoya, L, De Marco, G, Merashli, M, Wakefield, RJ, Emery, P, McGonagle, D, Tan, AL & Marzo-Ortega, H 2021, 'Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-naïve early psoriatic arthritis', Rheumatology Advances in Practice, vol. 5, no. 3, rkab086, pp. 1-12. https://doi.org/10.1093/rap/rkab086

TY - JOUR

T1 - Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-naïve early psoriatic arthritis

AU - Dubash, Sayam R

AU - Alabas, Oras A

AU - Michelena, Xabier

AU - Garcia-Montoya, Leticia

AU - De Marco, Gabriele

AU - Merashli, Mira

AU - Wakefield, Richard J

AU - Emery, Paul

AU - McGonagle, Dennis

AU - Tan, Ai Lyn

AU - Marzo-Ortega, Helena

N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.

PY - 2021/11/15

Y1 - 2021/11/15

N2 - Objective: To evaluate the relationship between clinical examination/US synovitis in DMARD-naïve early PsA. Methods: Eligible patients underwent matched clinical/US 44-joint assessment for tender and/or swollen joints (TJ/SJ) and US synovitis [grey scale (GS) ≥ 2 or power Doppler (PD) ≥ 1]. Statistical agreement between TJ/SJ, GS ≥ 2 and PD ≥ 1 was calculated by prevalence-adjusted and bias-adjusted κ (PABAK). To derive probabilities of GS ≥ 2/PD ≥ 1, mixed-effects logistic regression-modelled odds of US synovitis in TJ/SJ were conducted. Results: In 155 patients, 5616 joints underwent clinical/US examination. Of these joints, 1039 of 5616 (18.5%) were tender, 550 of 5616 (9.8%) were swollen, 1144 of 5616 (20.4%) had GS ≥ 2, and 292 of 5616 (5.2%) had PD ≥ 1. GS ≥ 2 was most prevalent in concomitantly tender and swollen joints [205 of 462 (44%)], followed by swollen non-tender joints [32 of 88 (36.4%)], tender non-swollen joints [148 of 577 (25.7%)] and non-tender non-swollen joints (subclinical synovitis) [759 of 4489 (16.9%)]. Agreement between SJ/PD ≥ 1 was high at the individual joint level (82.6-96.3%, PABAK 0.65-0.93) and for total joints combined (89.9%, PABAK 0.80). SJ/GS ≥ 2 agreement was greater than between TJ/GS ≥ 2 [73.5-92.6% vs 51.0-87.4% (PABAK 0.47-0.85 vs PABAK 0.35-0.75), respectively]. Swelling was independently associated with higher odds of GS ≥ 2 [odds ratio (OR) (95% CI); 4.37 (2.62, 7.29); P < 0.001] but not tenderness [OR = 1.33 (0.87, 2.06); P = 0.192]. Swelling [OR = 8.78 (3.92, 19.66); P < 0.001] or tenderness [OR = 3.38 (1.53, 7.50); P = 0.003] was independently associated with higher odds of PD ≥ 1. Conclusion: Synovitis (GS ≥ 2 and/or PD ≥ 1) was more likely in swollen joints than in tender joints in DMARD-naïve, early PsA. Agreement indicated that swollen joints were the better proxy for synovitis, adding to greater understanding between clinical and US assessments.

AB - Objective: To evaluate the relationship between clinical examination/US synovitis in DMARD-naïve early PsA. Methods: Eligible patients underwent matched clinical/US 44-joint assessment for tender and/or swollen joints (TJ/SJ) and US synovitis [grey scale (GS) ≥ 2 or power Doppler (PD) ≥ 1]. Statistical agreement between TJ/SJ, GS ≥ 2 and PD ≥ 1 was calculated by prevalence-adjusted and bias-adjusted κ (PABAK). To derive probabilities of GS ≥ 2/PD ≥ 1, mixed-effects logistic regression-modelled odds of US synovitis in TJ/SJ were conducted. Results: In 155 patients, 5616 joints underwent clinical/US examination. Of these joints, 1039 of 5616 (18.5%) were tender, 550 of 5616 (9.8%) were swollen, 1144 of 5616 (20.4%) had GS ≥ 2, and 292 of 5616 (5.2%) had PD ≥ 1. GS ≥ 2 was most prevalent in concomitantly tender and swollen joints [205 of 462 (44%)], followed by swollen non-tender joints [32 of 88 (36.4%)], tender non-swollen joints [148 of 577 (25.7%)] and non-tender non-swollen joints (subclinical synovitis) [759 of 4489 (16.9%)]. Agreement between SJ/PD ≥ 1 was high at the individual joint level (82.6-96.3%, PABAK 0.65-0.93) and for total joints combined (89.9%, PABAK 0.80). SJ/GS ≥ 2 agreement was greater than between TJ/GS ≥ 2 [73.5-92.6% vs 51.0-87.4% (PABAK 0.47-0.85 vs PABAK 0.35-0.75), respectively]. Swelling was independently associated with higher odds of GS ≥ 2 [odds ratio (OR) (95% CI); 4.37 (2.62, 7.29); P < 0.001] but not tenderness [OR = 1.33 (0.87, 2.06); P = 0.192]. Swelling [OR = 8.78 (3.92, 19.66); P < 0.001] or tenderness [OR = 3.38 (1.53, 7.50); P = 0.003] was independently associated with higher odds of PD ≥ 1. Conclusion: Synovitis (GS ≥ 2 and/or PD ≥ 1) was more likely in swollen joints than in tender joints in DMARD-naïve, early PsA. Agreement indicated that swollen joints were the better proxy for synovitis, adding to greater understanding between clinical and US assessments.

KW - PsA

KW - US

KW - clinical examination

KW - disease activity

KW - physical examination

KW - spondyloarthritis

KW - spondyloarthropathies

KW - synovitis

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U2 - 10.1093/rap/rkab086

DO - 10.1093/rap/rkab086

M3 - Article

C2 - 35284780

SN - 2514-1775

VL - 5

SP - 1

EP - 12

JO - Rheumatology Advances in Practice

JF - Rheumatology Advances in Practice

IS - 3

M1 - rkab086

ER -

Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-naïve early psoriatic arthritis

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