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Clinical and ultrasound concordance in the detection of synovitis in rheumatoid arthritis: a transversal study about 50 patients

Safaa Belghali, Nejla El Amri N, Houneida Zaghouani, Khadija Baccouche, Dorra Amri, Hela Zeglaoui & Elyes Bouajina

Objectives: Assessing the clinical ultrasound concordance in the detection of hands and wrists synovitis and determining the factors associated with such a concordance. Patients and methods: Single centre cross-sectional study related to 50 patients with Rheumatoid Arthritis (RA), included consecutively over a period of 21 months. The concordance between the clinical synovitis and the ultrasound one was assessed by calculating Cohen (k) coefficient. A correlation study between the concordance percentage at the patient scale with the clinical and biological parameters was conducted. Results: The concordance between the clinical examination and ultrasound in the detection of synovitis was too weak. The kappa coefficient varied from 0, 03 to 0, and 16. Likewise, the concordance between joint pain and ultrasound synovitis was overall at a low level (kappa between -0, 005 to 0, and 31) as well as the one between clinical signs (pain and/ or swelling) as well as ultrasound ones (synovial hypertrophy, effusion, Doppler signal) together, kappa coefficient was between 0, 03 and 0, 28. We objectified statistically significant positive correlations between the average concordance percentage and the low disease activity (DAS28˂3, 2). Conclusion: Concordance between clinical examination and ultrasound in the synovitis detection was overall at a low level. These observations indicate the best ultrasound sensitivity. Disease activity was the major factor influencing such a concordance in the present study.