Flares in rheumatoid arthritis: do patient-reported swollen and tender joints match clinical and ultrasonography findings?

Dorota Kuettel*, Lene Terslev, Ulrich Weber, Mikkel Østergaard, Jette Primdahl, Randi Petersen, Mads Ammitzbøll-Danielsen, Sören Möller, Kim Hørslev-Petersen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVES: To investigate how patient-reported flares in RA are related to clinical joint examination and inflammation detected by US.

METHODS: Eighty RA patients with DAS28-CRP <3.2 and no swollen joints at baseline were followed for 1 year. In case of patient-reported hand flare with swollen and tender joints (SJ and TJ, respectively), patients underwent clinical examination for SJ/TJ and US of bilateral wrists, MCP and PIP 1st-5th, six extensor tendon compartments and wrist flexor tendons for synovitis/tenosynovitis. Percentage agreement and kappa were calculated between patient-reported SJ and TJ, clinical examination for SJ/TJ and US findings indicative of inflammation. With US as reference, sensitivity, specificity, positive/negative predictive value and accuracy of patient-reported and clinically examined joints were determined.

RESULTS: Hand flare was reported by 36% (29/80) of patients. At time of flare, all clinical and ultrasonographic measures of disease activity deteriorated compared with baseline. Agreement between patient-reported SJ/TJ, clinically examined SJ/TJ and US was slight (kappa = 0.02-0.20). Patients and clinicians agreed in 79-93% of joints, more frequently on SJ than TJ. With US as reference, specificities were 86-100% and 88-100%, and sensitivities 12-34% and 4-32% for patient-reported SJ/TJ and clinically examined SJ/TJ, respectively.

CONCLUSION: Over 12 months of follow-up, hand flare was reported by every third RA patient. Self-reported flares were associated with increased disease activity as determined by clinical examination and US. Patient-reported joint assessment may aid in capturing flares between routine clinical visits.

Original languageEnglish
JournalRheumatology (Oxford, England)
Volume59
Issue number1
Pages (from-to)129-136
ISSN1462-0324
DOIs
Publication statusPublished - 1. Jan 2020

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Ultrasonography
Joints
Wrist

Keywords

  • flares
  • patient-reported outcomes
  • rheumatoid arthritis
  • ultrasonography

Cite this

@article{1d3dd1cd20f04a49a7c41f3bf982fa84,
title = "Flares in rheumatoid arthritis: do patient-reported swollen and tender joints match clinical and ultrasonography findings?",
abstract = "OBJECTIVES: To investigate how patient-reported flares in RA are related to clinical joint examination and inflammation detected by US.METHODS: Eighty RA patients with DAS28-CRP <3.2 and no swollen joints at baseline were followed for 1 year. In case of patient-reported hand flare with swollen and tender joints (SJ and TJ, respectively), patients underwent clinical examination for SJ/TJ and US of bilateral wrists, MCP and PIP 1st-5th, six extensor tendon compartments and wrist flexor tendons for synovitis/tenosynovitis. Percentage agreement and kappa were calculated between patient-reported SJ and TJ, clinical examination for SJ/TJ and US findings indicative of inflammation. With US as reference, sensitivity, specificity, positive/negative predictive value and accuracy of patient-reported and clinically examined joints were determined.RESULTS: Hand flare was reported by 36{\%} (29/80) of patients. At time of flare, all clinical and ultrasonographic measures of disease activity deteriorated compared with baseline. Agreement between patient-reported SJ/TJ, clinically examined SJ/TJ and US was slight (kappa = 0.02-0.20). Patients and clinicians agreed in 79-93{\%} of joints, more frequently on SJ than TJ. With US as reference, specificities were 86-100{\%} and 88-100{\%}, and sensitivities 12-34{\%} and 4-32{\%} for patient-reported SJ/TJ and clinically examined SJ/TJ, respectively.CONCLUSION: Over 12 months of follow-up, hand flare was reported by every third RA patient. Self-reported flares were associated with increased disease activity as determined by clinical examination and US. Patient-reported joint assessment may aid in capturing flares between routine clinical visits.",
keywords = "flares, patient-reported outcomes, rheumatoid arthritis, ultrasonography",
author = "Dorota Kuettel and Lene Terslev and Ulrich Weber and Mikkel {\O}stergaard and Jette Primdahl and Randi Petersen and Mads Ammitzb{\o}ll-Danielsen and S{\"o}ren M{\"o}ller and Kim H{\o}rslev-Petersen",
note = "{\circledC} The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.",
year = "2020",
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doi = "10.1093/rheumatology/kez231",
language = "English",
volume = "59",
pages = "129--136",
journal = "Rheumatology",
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Flares in rheumatoid arthritis : do patient-reported swollen and tender joints match clinical and ultrasonography findings? / Kuettel, Dorota; Terslev, Lene; Weber, Ulrich; Østergaard, Mikkel; Primdahl, Jette; Petersen, Randi; Ammitzbøll-Danielsen, Mads; Möller, Sören; Hørslev-Petersen, Kim.

In: Rheumatology (Oxford, England), Vol. 59, No. 1, 01.01.2020, p. 129-136.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Flares in rheumatoid arthritis

T2 - do patient-reported swollen and tender joints match clinical and ultrasonography findings?

AU - Kuettel, Dorota

AU - Terslev, Lene

AU - Weber, Ulrich

AU - Østergaard, Mikkel

AU - Primdahl, Jette

AU - Petersen, Randi

AU - Ammitzbøll-Danielsen, Mads

AU - Möller, Sören

AU - Hørslev-Petersen, Kim

N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - OBJECTIVES: To investigate how patient-reported flares in RA are related to clinical joint examination and inflammation detected by US.METHODS: Eighty RA patients with DAS28-CRP <3.2 and no swollen joints at baseline were followed for 1 year. In case of patient-reported hand flare with swollen and tender joints (SJ and TJ, respectively), patients underwent clinical examination for SJ/TJ and US of bilateral wrists, MCP and PIP 1st-5th, six extensor tendon compartments and wrist flexor tendons for synovitis/tenosynovitis. Percentage agreement and kappa were calculated between patient-reported SJ and TJ, clinical examination for SJ/TJ and US findings indicative of inflammation. With US as reference, sensitivity, specificity, positive/negative predictive value and accuracy of patient-reported and clinically examined joints were determined.RESULTS: Hand flare was reported by 36% (29/80) of patients. At time of flare, all clinical and ultrasonographic measures of disease activity deteriorated compared with baseline. Agreement between patient-reported SJ/TJ, clinically examined SJ/TJ and US was slight (kappa = 0.02-0.20). Patients and clinicians agreed in 79-93% of joints, more frequently on SJ than TJ. With US as reference, specificities were 86-100% and 88-100%, and sensitivities 12-34% and 4-32% for patient-reported SJ/TJ and clinically examined SJ/TJ, respectively.CONCLUSION: Over 12 months of follow-up, hand flare was reported by every third RA patient. Self-reported flares were associated with increased disease activity as determined by clinical examination and US. Patient-reported joint assessment may aid in capturing flares between routine clinical visits.

AB - OBJECTIVES: To investigate how patient-reported flares in RA are related to clinical joint examination and inflammation detected by US.METHODS: Eighty RA patients with DAS28-CRP <3.2 and no swollen joints at baseline were followed for 1 year. In case of patient-reported hand flare with swollen and tender joints (SJ and TJ, respectively), patients underwent clinical examination for SJ/TJ and US of bilateral wrists, MCP and PIP 1st-5th, six extensor tendon compartments and wrist flexor tendons for synovitis/tenosynovitis. Percentage agreement and kappa were calculated between patient-reported SJ and TJ, clinical examination for SJ/TJ and US findings indicative of inflammation. With US as reference, sensitivity, specificity, positive/negative predictive value and accuracy of patient-reported and clinically examined joints were determined.RESULTS: Hand flare was reported by 36% (29/80) of patients. At time of flare, all clinical and ultrasonographic measures of disease activity deteriorated compared with baseline. Agreement between patient-reported SJ/TJ, clinically examined SJ/TJ and US was slight (kappa = 0.02-0.20). Patients and clinicians agreed in 79-93% of joints, more frequently on SJ than TJ. With US as reference, specificities were 86-100% and 88-100%, and sensitivities 12-34% and 4-32% for patient-reported SJ/TJ and clinically examined SJ/TJ, respectively.CONCLUSION: Over 12 months of follow-up, hand flare was reported by every third RA patient. Self-reported flares were associated with increased disease activity as determined by clinical examination and US. Patient-reported joint assessment may aid in capturing flares between routine clinical visits.

KW - flares

KW - patient-reported outcomes

KW - rheumatoid arthritis

KW - ultrasonography

U2 - 10.1093/rheumatology/kez231

DO - 10.1093/rheumatology/kez231

M3 - Journal article

C2 - 31382292

VL - 59

SP - 129

EP - 136

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 1

ER -