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Musculoskeletal ultrasonography assists the diagnostic performance of the 2010 classification criteria for rheumatoid arthritis

  • Original Article
  • Published:
Modern Rheumatology

Abstract

Objective

We investigated whether musculoskeletal ultrasonography (MSKUS) assists the diagnostic performance of the 2010 rheumatoid arthritis (RA) classification criteria.

Methods

Sixty-nine early arthritis patients were consecutively enrolled. None of the patients had been treated. In MSKUS of bilateral wrist and finger joints from 22 sites, the findings obtained by gray-scale and power Doppler (PD) assessment were graded on a semiquantitative scale from 0 to 3. Plain magnetic resonance imaging (MRI) of both wrist and finger joints was also examined. Diagnosis of RA was defined by the initiation of disease-modifying antirheumatic drugs within the first 3 months. The diagnostic performance of the patients was evaluated at entry using 2010 RA classification criteria in conjunction with MSKUS.

Results

The indispensable MSKUS finding for differentiating RA was the presence of a PD grade 2 or 3 that was superior to 2010 RA classification criteria or MRI-proven bone edema. We propose that the decision tree algorithm of 2010 RA classification criteria with PD grade 2 or 3 reveals the best discriminative ability.

Conclusion

MSKUS, especially with a strong PD signal, is very useful to assist the diagnostic performance of the 2010 RA classification criteria in the early recognition of RA.

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Abbreviations

ACPA:

Anticyclic citrullinated peptide antibody

ACR:

American College of Rheumatology

CRP:

C-reactive protein

DMARDs:

Disease-modifying antirheumatic drugs

ESR:

Erythrocyte sedimentation rate

EULAR:

European League Against Rheumatism

Gd-DTPA:

Gadolinium-diethylenetriamine pentaacetic acid

GS:

Gray-scale

IP:

Interphalangeal

MCP:

Metacarpophalangeal

MMP:

Matrix metalloproteinase

MRI:

Magnetic resonance imaging

MSKUS:

Musculoskeletal ultrasonography

NPV:

Negative predictive value

PD:

Power Doppler

PIP:

Proximal interphalangeal

PPV:

Positive predictive value

RA:

Rheumatoid arthritis

RF:

Rheumatoid factor

SJC:

Swollen joint counts

T2T:

Treat to target

TJC:

Tender joint counts

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Authors and Affiliations

  1. Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Shin-ya Kawashiri, Takahisa Suzuki, Akitomo Okada, Satoshi Yamasaki, Hideki Nakamura & Atsushi Kawakami

  2. Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan

    Mami Tamai

  3. Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Tomoki Origuchi

  4. Department of Internal Medicine, Nagasaki Municipal Hospital, Omura, Japan

    Akinari Mizokami

  5. Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Masataka Uetani

  6. Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Kiyoshi Aoyagi

  7. Department of Internal Medicine, Sasebo City General Hospital, Sasebo, Japan

    Katsumi Eguchi

Authors
  1. Shin-ya Kawashiri
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  2. Takahisa Suzuki
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  3. Akitomo Okada
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  4. Satoshi Yamasaki
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  5. Mami Tamai
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  6. Hideki Nakamura
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  7. Tomoki Origuchi
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  8. Akinari Mizokami
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  9. Masataka Uetani
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  11. Katsumi Eguchi
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  12. Atsushi Kawakami
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Corresponding author

Correspondence to Shin-ya Kawashiri.

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Kawashiri, Sy., Suzuki, T., Okada, A. et al. Musculoskeletal ultrasonography assists the diagnostic performance of the 2010 classification criteria for rheumatoid arthritis. Mod Rheumatol 23, 36–43 (2013). https://doi.org/10.1007/s10165-012-0628-7

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  • DOI: https://doi.org/10.1007/s10165-012-0628-7

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